<p>Su nombre (requerido)<br />
    [text* your-name] </p>

<p>Su e-mail (requerido)<br />
    [email* your-email] </p>

<p>Asunto<br />
    [text your-subject] </p>

<p>Su mensaje<br />
    [textarea your-message] </p>

<p>Ingrese código<br />
[captchac captcha-961] [captchar captcha-961]</p>

<p>[submit "Enviar"]</p>