<meta http-equiv="Content-Type" content="text/html; charset=utf-8" /><form id="emf-form" target="_self" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/54fG3Ckf0eml0636vIRZV6dFp"> <table style="text-align:left;" cellpadding="2" width="100%" cellspacing="0" border="0" bgcolor="#FFFFFF"> <tr> <td style="" > <font face="Verdana" size="2" color="#000000">Anda ingin bertanya ?, Silahkan isi Form di bawah:<br /></label><br /></font> </td> </tr><tr valign="top" ><td id="td_element_label_0" style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Nama Lengkap</b></font> <span style="color:red;"><small>*</small></span> <input id="element_0" name="element_0" value="" size="30" class="form-control validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div> </td> </tr><tr valign="top" ><td id="td_element_label_1" style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Email</b></font> <span style="color:red;"><small>*</small></span> <input id="element_1" name="element_1" class="form-control validate[required,custom[email]]" value="" size="30" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div> </td> </tr><tr valign="top" ><td id="td_element_label_2" style="" align="left"><font face="Verdana" size="2" color="#000000"><b>No HP</b></font> <span style="color:red;"><small>*</small></span> <input id="element_2" name="element_2" class="form-control validate[required,custom[onlyNumber]]" value="" size="30" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div> </td> </tr><tr valign="top" ><td id="td_element_label_3" style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Alamat Lengkap</b></font> <span style="color:red;"><small></small></span> <input id="element_3" name="element_3" value="" size="45" class="form-control validate[optional]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div> </td> </tr><tr valign="top" ><td id="td_element_label_4" style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Pertanyaan</b></font> <span style="color:red;"><small></small></span> <textarea id="element_4" name="element_4" cols="45" rows="10" class="form-control validate[optional] "></textarea><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div> </td> </tr><tr><td colspan="2" align="left"> <input name="element_counts" value="5" type="hidden" /> <input name="embed" value="forms" type="hidden" /><input class="btn btn-success btn-block" value="Kirim" type="submit" /> </td></tr></table></form>