<!--includeForm-->



<form method="post">




 
<span class="input_name">Ф.И.О.:</span><input type="text" size="30" maxlength="100" value="" name="d[0]" id="d[0]" />

<br />


 
<span class="input_name">e-mail:</span><input type="text" size="30" maxlength="100" value="" name="d[1]" id="d[1]" />

<br />


 
<span class="input_name">Телефон:</span><input type="text" size="30" maxlength="100" value="" name="d[2]" id="d[2]" />

<br />


 
<span class="input_name ta_sp">Сообщение:</span><textarea cols="50" rows="7" name="d[3]" id="d[3]"></textarea>

<br />





 

<style>img.captcha {
border:1px solid gray;
}</style>


<span style="padding:0 0 0 87px;">Подтвердите, что Вы не робот:</span><br />

<img style="margin:0 0 0 87px;" class="captcha" src=".gif" align="absmiddle">&nbsp;&nbsp;<input style="width:100px;" type="text" size="5" maxlength="4" name="_cn">

<input type="hidden" value="" name="_cs"><br>


<br clear="all">

<input type="submit" value="Отправить" class="call_submit"><re-captcha data-captcha="recaptcha"
     data-name="captcha"
     data-sitekey="6LcNwrMcAAAAAOCVMf8ZlES6oZipbnEgI-K9C8ld"
     data-lang="ru"
     data-rsize="invisible"
     data-type="image"
     data-theme="light"></re-captcha></form>




<!--includeForm-->
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