<div class="feedback">
 <div class="fb_tit">First Name *</div>
 <input class="fb_inp" type="text" name="f4" size="30" maxlength="70"/>
 <div class="fb_tit">Your e-mail *</div>
 <input class="fb_inp" type="text" name="f1" size="30" maxlength="70"/>
 <div class="fb_tit">Company Name</div>
 <input class="fb_inp" type="text" name="f8" size="30" maxlength="70"/>
 <div class="fb_tit">Subject</div>
 <input class="fb_inp" type="text" name="f2" size="30" maxlength="70"/>
 <div class="fb_tit">Message * </div>
 <textarea class="fb_text" rows="7" name="f3" cols="30"></textarea>
 <div><input class="fb_send" type="submit" value="Send"/></div>
</div>