HTML code for "Contact Us" form

Click here to see how your form will look like

This form is completely customizable!
JavaScript validates required fields; plus there is a verification on the server-side.
Captcha image protects the form against SPAM.
Captcha image can be reloaded.
There are many styles of Captcha image available.


This is ProCaptcha code. Free BasicCaptcha code is here.

How to use ProCaptcha code

1. Create an account if you have not done it yet.

2. Copy and paste the code below into your webpage.

3. Specify a form in your profile with SnapHostID KEUY9QBE7T56.


<div style="width: 650px; font-size: 0.9em;" class="ui-widget ui-corner-all">
<div style="padding: 4px 20px;" class="ui-widget-header ui-corner-top">Contact Us</div>
<div style="padding: 20px;" class="ui-widget-content ui-corner-bottom">
<link rel="stylesheet" href="http://ajax.googleapis.com/ajax/libs/jqueryui/1.8/themes/redmond/jquery-ui.css" />
<form action="http://www.SnapHost.com/captcha/WebFormSubmit.aspx" id="ContactUsCaptchaWebForm" method="post" onsubmit="return ValidateForm(this);">
<input name="SnapHostID" type="hidden" value="KEUY9QBE7T56" />
<script type="text/javascript">
function ValidateForm(frm) {
if (frm.Name.value == "") {alert('Name is required.');frm.Name.focus();return false;}
if (frm.FromEmailAddress.value == "") {alert('Email address is required.');frm.FromEmailAddress.focus();return false;}
if (frm.FromEmailAddress.value.indexOf("@") < 1 || frm.FromEmailAddress.value.indexOf(".") < 1) {alert('Please enter a valid email address.');frm.FromEmailAddress.focus();return false;}
if (frm.Comments.value == "") {alert('Please enter comments or questions.');frm.Comments.focus();return false;}
if (frm.CaptchaCode.value == "") {alert('Enter web form code.');frm.CaptchaCode.focus();return false;}
return true; }
function ReloadCaptchaImage(captchaImageId) {
var obj = document.getElementById(captchaImageId);
var src = obj.src;
var date = new Date();
var pos = src.indexOf('&rad=');
if (pos >= 0) { src = src.substr(0, pos); }
obj.src = src + '&rad=' + date.getTime();
return false; }
</script>
<table border="0" cellpadding="5" cellspacing="0" width="600">
<tr>
<td><b>Name*:</b></td>
<td><input name="Name" type="text" maxlength="60" style="width:350px; border:1px solid #999999;" class="ui-corner-all" /></td>
</tr><tr>
<td><b>Phone number:</b></td>
<td><input name="PhoneNumber" type="text" maxlength="43" style="width:350px; border:1px solid #999999;" class="ui-corner-all" /></td>
</tr><tr>
<td><b>Email address*:</b></td>
<td><input name="FromEmailAddress" type="text" maxlength="60" style="width:350px; border:1px solid #999999;" class="ui-corner-all" /></td>
</tr><tr>
<td><b>Comments and questions*:</b></td>
<td><textarea name="Comments" rows="7" cols="40" style="width:350px; border:1px solid #999999;" class="ui-corner-all"></textarea></td>
</tr><tr>
<td colspan="2" align="center"> <br />
<table border="0" cellpadding="0" cellspacing="0">
<tr valign="top">
<td> <i>Enter web form code*:</i>
<input name="CaptchaCode" type="text" style="width:80px; border:1px solid #999999;" maxlength="6" class="ui-corner-all" />
</td><td>
<a href="http://www.SnapHost.com"><img id="CaptchaImage" alt="Web Form Code" title="Anti-spam web forms"
style="margin-left:20px; border:1px solid #999999;" class="ui-corner-all"
src="http://www.SnapHost.com/captcha/WebForm.aspx?id=KEUY9QBE7T56&ImgType=2" /></a><br />
<a href="#" onclick="return ReloadCaptchaImage('CaptchaImage');"><span style="font-size:12px;">reload image</span></a> </td></tr>
</table> <br />
* - required fields. &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;
<input name="skip_Submit" type="submit" value="Submit" />
</td></tr>
</table><br />
</form>
</div>
</div>