<div dir="ltr" style="text-align: left;" trbidi="on">

<form action="//submit.form" id="ContactUs100" method="post" onsubmit="return ValidateForm(this);">

<script type="text/javascript">

function ValidateForm(frm) {

if (frm.Name.value == "") { alert('Name is required.'); frm.Name.focus(); return false; }

if (frm.FromEmailAddress.value == "") { alert('Email address is required.'); frm.FromEmailAddress.focus(); return false; }

if (frm.FromEmailAddress.value.indexOf("@") < 1 || frm.FromEmailAddress.value.indexOf(".") < 1) { alert('Please enter a valid email address.'); frm.FromEmailAddress.focus(); return false; }

if (frm.Comments.value == "") { alert('Please enter comments or questions.'); frm.Comments.focus(); return false; }

return true; }

</script>

<br />

<table cellpadding="8" cellspacing="0" style="border: 0px; width: 550px;">

<tbody>

<tr> <td><label>Name*:</label>

</td> <td><input maxlength="60" name="Name" style="width: 250px;" type="text" />

</td> </tr>

<tr> <td><label>Phone number:</label>

</td> <td><input maxlength="43" name="PhoneNumber" style="width: 250px;" type="text" />

</td> </tr>

<tr> <td><label>Email address*:</label>

</td> <td><input maxlength="90" name="askimasti@gmail.com" style="width: 250px;" type="text" />

</td> </tr>

<tr> <td><label>Comments*:</label>

</td> <td><textarea cols="40" name="Comments" rows="7" style="width: 350px;"></textarea>

</td> </tr>

<tr> <td>* - required fields

</td> <td><div style="float: right;">

</div>

<input name="skip_Submit" type="submit" value="Submit" />

<script src="https://www.100forms.com/js/FORMKEY:33UNLHXY2NDN/SEND:my@email.com" type="text/javascript"></script>

</td> </tr>

</tbody></table>

</form>

</div>