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.

How to use free BasicCaptcha code

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

2. Change the email address to your own email address.

3. Change the return address to your website address.

4. You can also change the email subject - Contact Us Captcha Form.

Warning: BasicCaptcha image has a link pointing to our site and promoting us; you must not remove the link, otherwise your site will be automatically banned in few days without warning. Do not add nofollow attribute!
If you don't like having a link then consider using our ProCaptcha form instead - click here.

<h2>Contact Us</h2>
<form action="" id="ContactUsCaptchaWebForm" method="post" onsubmit="return ValidateForm(this);" target="_top">
<input name="skip_WhereToSend" type="hidden" value="" />
<input name="skip_SnapHostID" type="hidden" value="TMZ4X7LRXFEE" />
<input name="skip_WhereToReturn" type="hidden" value="" />
<input name="skip_Subject" type="hidden" value="Contact Us Form" />
<input name="skip_ShowUsersIp" type="hidden" value="1" />
<input name="skip_SendCopyToUser" type="hidden" value="1" />
<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.skip_CaptchaCode.value == "") {alert('Enter web form code.');frm.skip_CaptchaCode.focus();return false;}
return true; }
function ReloadCaptchaImage(captchaImageId) {
var obj = document.getElementById(captchaImageId);
var src = '' + obj.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; }
<table border="0" cellpadding="5" cellspacing="0" width="600">
<td><input name="Name" type="text" maxlength="60" style="width:350px;" /></td>
<td><b>Phone number:</b></td>
<td><input name="PhoneNumber" type="text" maxlength="43" style="width:350px;" /></td>
<td><b>Email address*:</b></td>
<td><input name="FromEmailAddress" type="text" maxlength="60" style="width:350px;" /></td>
<td><b>Comments and questions*:</b></td>
<td><textarea name="Comments" rows="7" cols="40" style="width:350px;"></textarea></td>
<td colspan="2" align="center"> <br />
<table border="0" cellpadding="0" cellspacing="0">
<tr><td colspan="2" style="padding-bottom:18px;">
<!-- Please check our ProCaptcha service which is ad-free: -->
<a href="" alt="forms online" title="forms online">
forms online</a></td></tr>
<tr valign="top"><td> <i>Enter web form code*:</i>
<input name="skip_CaptchaCode" type="text" style="width:80px;" maxlength="6" />
<a href=""><img id="CaptchaImage" alt="Contact Us form" title="HTML code for Contact Us form"
src="" /></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" />
</table><br />