<form role="form" method="post">
    
    <div class="row">
        <div class="col-sm-5">
            <div class="form-group">
                <label for="from" class="control-label">
                    <?php echo __('First and Last Name'); ?>
                </label>
                <input name="from" class="form-control" value="<?php echo getKbPostVar('from', sprintf('%s %s', $this->user->first_name, $this->user->last_name))?>"/>
            </div>
        </div>
    </div>
    
    
    <div class="row">
        <div class="col-sm-5">
            <div class="form-group">
                <label for="type" class="control-label">
                    <?php echo __('I want to:'); ?>
                </label>
                <select name="type" class="form-control">
                    <option value="help"><?php echo __('get help');?></option>
                    <option value="feedback"><?php echo __('give feedback');?></option>
                    <option value="bug"><?php echo __('report a bug');?></option>
                    <option value="suggest"><?php echo __('suggest');?></option>
                    <option value="hello"><?php echo __('say hello');?></option>
                    <option value="buy_themes"><?php echo __('buy themes');?></option>
                    <option value="other"><?php echo __('express other matter');?></option>
                </select>
            </div>
        </div>
    </div> 
    
    <div class="row">
        <div class="col-sm-5">
            <div class="form-group">
                <label for="title" class="control-label">
                    <?php echo __('Title'); ?>
                </label>
                <input name="title" class="form-control" />
            </div>
        </div>
    </div>
    <div class="row">
        <div class="col-sm-5">
            <div class="form-group">
                <label for="comment" class="control-label">
                    <?php echo __('Tell us more'); ?>*
                </label>
                <textarea name="comment" class="form-control" rows="5"></textarea>
            </div>
        </div>
    </div>
    
    <div class="row">
        <div class="col-sm-5">
            <div class="form-group">
                <label for="replyto" class="control-label">
                    <?php echo __('Reply to'); ?>*
                </label>
                <input name="replyto" value="<?php echo $this->user->user_email; ?>" class="form-control" />
            </div>
        </div>
    </div>
    
    <div class="row">
        <div class="col-sm-5">
            <div class="form-group">
                <label for="support_id" class="control-label">
                    <?php echo __('Support Id'); ?>*
                </label>
                <input name="support_id" value="<?php echo getKbAmz()->getStoreId(); ?>" class="form-control" disabled="disabled"/>
            </div>
        </div>
    </div>
        
    <button type="submit" class="btn btn-primary" name="import" value="submit"><?php echo __('Send'); ?></button>
</form>


