<div class="bl_modal_body">
    <div class="modal-body">
        <div class="bl_forms">
            <div class="section fields">
            <!-- begin_contact_email -->
            <div class="col-lg-12 col-md-12 field">
                <input name="contact_email" type="text" class="form-control placeholder" placeholder="{l_email}">
            </div>
            <!-- end_contact_email -->
            <!-- begin_contact_username -->
            <div class="col-lg-12 col-md-12 field">
                <input name="contact_username" type="text" class="form-control placeholder" placeholder="{l_username}">
            </div>
            <!-- end_contact_username -->

            <div class="col-lg-12 col-md-12 field_textarea">
                <textarea name="contact_comment" class="form-control placeholder" placeholder="{l_type_your_message_here}"></textarea>
            </div>
            <!-- begin_contact_captcha -->
            <!-- begin_default_captcha -->
            <div class="col-lg-12 col-md-12 field">
                <img id="pp_contact_captcha" class="captcha" title="{a_show_another_code}" onclick="refreshCaptcha(); return false;" src="{url_main}_server/securimage/securimage_show_custom.php?sid={sid}"/>
            </div>
            <div class="col-lg-12 col-md-12 field">
                <input name="contact_captcha" type="text" class="form-control placeholder" placeholder="{l_enter_code}"/>
            </div>
            <!-- end_default_captcha -->
            <!-- begin_re_captcha -->
            <div class="col-lg-12 col-md-12 field bl_contact_recaptcha">
                <div id="contact_recaptcha"  class="contact_recaptcha"></div>
            </div>
            <!-- end_re_captcha -->
            <!-- end_contact_captcha -->
            </div>
        </div>
        <div class="clearfix"></div>
    </div>
    <div class="modal-footer">
        <div class="col-lg-12 col-md-12">
            <button type="button" class="btn btn-success contact_submit">
                <span class="icon message"></span><span>{l_send}</span>
            </button>
        </div>
    </div>

    <script>
    var responseRecaptchaContact='', isRecaptchaContact=false, captchaContact='';
    <!-- begin_re_captcha_js -->
    isRecaptchaContact=true;
    var recaptchaWdContact,
    verifyCallbackContact = function(response) {
        captchaContact = grecaptcha.getResponse(recaptchaWdContact);
        hideError('#contact_recaptcha');
    },
    onloadCallbackContact = function() {
        recaptchaWdContact = grecaptcha.render('contact_recaptcha', {
            'sitekey' : '{re_captcha_sitekey}',
            'callback' : verifyCallbackContact,
            'theme' : '{re_captcha_theme}'
        });
    };
    <!-- end_re_captcha_js -->
    </script>
    <!-- begin_re_captcha_script -->
    <script src="//www.google.com/recaptcha/api.js?onload=onloadCallbackContact&render=explicit&hl={re_captcha_lang}" async defer></script>
    <!-- end_re_captcha_script -->
</div>