Example1 - Form Example - Email

Prefix: <nameprefix>
Name: <name>
Department/Organization: <dept>
Phone Number: <phone>
Email: <email>

What colors do you like? Check all that apply.
<color1>
<color2>
<color3>
<color4>
<color5>
<color6>

Comments: 
<comments>


*** Below are some of the variables built into the feedback form system: ***
Date and Time: <date> <time>
Client IP: <client_ip>
Refer: <refer>