<div id="content">
	<div class="row">
		<h1>Contact Us</h1>
		<h3>Proudly Serving</h3>
		<h4>Orange Park - Fleming Island - Green Cove Springs</h4>
		<h4>St. Johns - St. Augustine - Middleburg</h4>
		<form action="sendContactForm" method="post"  class="sends-email ctc-form" >
			<label>
				<input type="text" name="name" placeholder="Name:">
			</label>
			<label>
				<input type="text" name="address" placeholder="Address:">
			</label>
			<label>
				<input type="text" name="email" placeholder="Email:">
			</label>
			<label>
				<input type="text" name="phone" placeholder="Phone:">
			</label>
			<label>
				<textarea name="message" cols="30" rows="10" placeholder="Message:"></textarea>
			</label>
			<p class="txt-radio">Subscribe to our Comfort club plan:</p>
			<div class="radio">
				<input type="radio" id="platinum" name="platinum" value="Platinum" placeholder="Platinum">
				<label class="platinum" for="platinum">Platinum</label>
				<input type="radio" id="gold" name="gold" value="CSS" placeholder="Gold">
				<label class="gold" for="gold">Gold</label>
				<input type="radio" id="silver" name="silver" value="JavaScript" placeholder="Silver">
				<label class="silver" for="silver">Silver</label>
			</div>
			<div class="consent">
				<label>
					<input type="checkbox" name="consent" class="consentBox">I hereby consent to having this website store my submitted information so that they can respond to my inquiry.
				</label><br>
				<?php if( $this->siteInfo['policy_link'] ): ?>
				<label>
					<input type="checkbox" name="termsConditions" class="termsBox"/> I hereby confirm that I have read and understood this website's <a href="<?php $this->info("policy_link"); ?>" target="_blank">Privacy Policy.</a>
				</label>
				<?php endif ?>
			</div>
			<div class="g-recaptcha"></div>
			<button type="submit" class="btn">Submit Form</button>
		</form>
	</div>
</div>