<table> <tbody> <tr> <td class="style2"> [title_name] </td> <td class="style6"> [txt_name] </td> </tr> <tr> <td class="style2"> [title_email] </td> <td class="style6"> [txt_email] </td> </tr> <tr> <td class="style2"> [title_phone] </td> <td class="style6"> [txt_phone] </td> </tr> <tr> <td class="style2"> [title_country] </td> <td class="style6"> [txt_country] </td> </tr> <tr> <td class="style2"> [title_state] </td> <td class="style6"> [txt_state] </td> </tr> <tr> <td class="style2"> [title_address] </td> <td class="style6"> [txt_address] </td> </tr> <tr> <td class="style2"> [title_remarks] </td> <td class="style6"> [txt_remarks] </td> </tr> <tr> <td> </td> <td> [captcha]</td> </tr> <tr> <td> </td> <td>[submit][cancel]</td> </tr> </tbody> </table>