{header}


    <div id="main_r">

<div class="main_bgrnd_padding">
<div id="columns" align="left" style="position: relative;">

<script Language="JavaScript" type="text/javascript">

    var captcha = '';
    <!-- begin_re_captcha_js -->
    var verifyCallback = function(response) {
        captcha = grecaptcha.getResponse(recaptchaWd);
        $('#recaptcha_input').val(captcha);
    };
    var onloadCallback = function() {
        recaptchaWd = grecaptcha.render('recaptcha', {
            'sitekey' : '{re_captcha_sitekey}',
            'callback' : verifyCallback,
            'theme' : '{re_captcha_theme}'
        });
    };
    <!-- end_re_captcha_js -->

    function onValidateNMContactUsForm() {
        var form = document.forms['NMContactUsForm'];

        <!-- begin_default_captcha_js -->
        captcha = form['captcha'].value;
        <!-- end_default_captcha_js -->
        if ($.trim(captcha)=='') {
            alert('{j_incorrect_captcha}');
            $('#captcha_input').focus();
            return false;
        }

        // "contact_name" field validation.
        if (!validateRequiredField(form['contact_name'], '{j_name}')) {
            removeSubmissionBlock();
            return false;
        }
        // "contact_name" field validation.
        if (!validateMaxLength(form['contact_name'], '{j_name}','200')) {
            removeSubmissionBlock();
            return false;
        }
        // "phone" field validation.
        if (!validateNumericWS(form['phone'], '{j_phone_number}')) {
            removeSubmissionBlock();
            return false;
        }
        // "email" field validation.
        if (!validateRequiredField(form['email'], '{j_email_address}')) {
            removeSubmissionBlock();
            return false;
        }
        // "email" field validation.
        if (!validateMaxLength(form['email'], '{j_email_address}','100')) {
            removeSubmissionBlock();
            return false;
        }
        // "email" field validation.
        if (!validateEmailField(form['email'], '{j_email_address}')) {
            removeSubmissionBlock();
            return false;
        }
        // "comments" field validation.
        if (!validateRequiredField(form['comment'], '{j_comments}')) {
            removeSubmissionBlock();
            return false;
        }
        return true;
    }

    function validateNMContactUsForm() {
        blockSubmission = true;
        if (typeof beforeNMContactUsFormValidation != 'undefined') {
            beforeNMContactUsFormValidation();
        }
        var validated = onValidateNMContactUsForm();
        if (validated && (typeof uponSuccessfulNMContactUsFormValidation != 'undefined')) {
            validated = uponSuccessfulNMContactUsFormValidation();
        }
        else if (!validated && (typeof uponUnsuccessfulNMContactUsFormValidation != 'undefined')) {
            uponUnsuccessfulNMContactUsFormValidation();
        }
        if (!validated) {
            removeSubmissionBlock();
        }
        return validated;
    }

    function submitNMContactUsForm() {
        if (validateNMContactUsForm()) document.NMContactUsForm.submit();
    }

    function refreshCaptcha(){
        var captcha='#img_join_captcha';
        $(captcha).attr('src','{url_main}_server/securimage/securimage_show_custom.php?sid=' + Math.random());
        return false;
    }

</script>
<form  name="NMContactUsForm" method="POST" action="{url_main}partner/contact.php" onSubmit="return validateNMContactUsForm();" style="padding: 0px; margin: 0px;">

<input type="hidden" name="cmd" value="send" />

<div style="text-align:left;">
<div class="contentpad content_bgrnd">
  <div class="ter_big">{l_contact_us}</div>
  <div style="height: 10px;"><span></span></div>
  <div style="color:red;"><span>{contact_message}</span></div>

  <div style="padding-top: 8px;">{l_please_enter}</div>
  <div class="body">{l_feilds_with} ( <span class="red">*</span> ) {l_are_required}</div>
  <div style="height: 10px;"><span></span></div>

  <div>
    <table border="0" cellpadding="0" cellspacing="0" width="100%" align="center"><tr class="advsview2" style="height: 30px;">
      <td align="right" style="color: #31556F;" valign="middle" width="20%">{l_company_name}:&nbsp;&nbsp;</td>
      <td align="left" valign="middle" width="80%"><input class="contact_input" type="text" name="name" tabindex="6"></td>
    </tr><tr class="advsview1" style="height: 30px;">
      <td align="right" style="color: #31556F;" valign="middle" width="20%">{l_your_name}:&nbsp;&nbsp;</td>
      <td align="left" valign="middle" width="80%"><input type="text" name="contact_name" class="contact_input" tabindex="7"><span style="color: red;">*</span></td>
    </tr><tr class="advsview2" style="height: 30px;">
      <td align="right" style="color: #31556F;" valign="middle" width="20%">{l_phone}:&nbsp;&nbsp;</td>
      <td align="left" valign="middle" width="80%"><input type="text" name="phone" class="contact_input" tabindex="8"></td>
    </tr><tr class="advsview1" style="height: 30px;">
      <td align="right" style="color: #31556F;" valign="middle" width="20%">{l_email}:&nbsp;&nbsp;</td>
      <td align="left" valign="middle" width="80%"><input type="text" name="email" class="contact_input" tabindex="9"><span style="color: red;">*</span></td>
    </tr><tr class="advsview2" style="height: 30px;">
      <td align="right" style="color: #31556F;" valign="middle" width="20%">{l_affiliate_lofin}:&nbsp;&nbsp;</td>
      <td align="left" valign="middle" width="80%"><input type="text" name="username" class="contact_input" tabindex="10"></td>
    </tr><tr class="advsview1" style="height: 100px;">
      <td align="right" style="color: #31556F; padding-top: 10px;" valign="top" width="20%">{l_comments}:&nbsp;&nbsp;</td>
      <td align="left" valign="top" width="80%" style="padding-top: 10px;">
        <textarea   name="comment" class="contact_textarea" tabindex="11" rows="5"></textarea><span style="color: red;">*</span>
      </td>
    </tr>

    <!-- begin_default_captcha -->
    <tr class="advsview1" style="height: 40px;">
      <td align="right" style="color: #31556F; padding-top: 10px;" valign="top" width="20%">{l_enter_code}:&nbsp;&nbsp;</td>
      <td align="left" valign="top" width="80%" style="padding-top: 5px;">
        <div style="width:95px; float:left;">
            <img style="width:100%;" title="{l_refresh}" class="img_captcha" id="img_join_captcha" onclick="refreshCaptcha();" src="{url_main}_server/securimage/securimage_show_custom.php?sid={sid}">
        </div>
        <div class="refresh_captcha">
            <img title="{l_refresh}" onclick="refreshCaptcha();" src="{url_tmpl_partner}images/undo.png">
        </div>
        <div class="input_captcha">
            <input id="captcha" name="captcha" class="inp" type="text" value=""/>
            <span style="color: red;">*</span>
        </div>
      </td>
    </tr>
    <!-- end_default_captcha -->
    <!-- begin_re_captcha -->
    <tr class="advsview1" style="height: 100px;">
      <td align="right" style="color: #31556F; padding-top: 10px;" valign="top" width="20%"></td>
      <td align="left" valign="top" width="80%" style="padding-top: 5px;">
        <div style="float:left; height: 76px;">
            <div id="recaptcha" style="margin-left: 0px; margin-top: 5px;"></div>
        </div>
        <input id="recaptcha_input" name="recaptcha" type="hidden" value=""/>
      </td>
    </tr>
    <!-- end_re_captcha -->
    <tr>
    	<td colspan="2">
		   	<table border="0" cellpadding="0" cellspacing="0">
				<tr>
					<td width="145"></td>
					<td><div class="button_border_2 contact_submit"><input type="button" value="{a_submit}" onClick="setFlag(); submitNMContactUsForm();" class="button_2" style=" padding-left: 5px; padding-right: 5px;cursor: pointer; cursor: hand;" tabindex="13" title="{a_submit}" onMouseOver="window.status='{a_submit}'; return true;" onMouseOut="window.status=''; return true;"></div>
					</td>
				</tr>
    		</table>
    	</td>
	</tr>
    </table>
  </div>
  <div style="height: 20px;"><span></span></div>
</div>
</div>
</form>
</div>
</div>
</div>

<!-- begin_re_captcha_script -->
<script src="//www.google.com/recaptcha/api.js?onload=onloadCallback&render=explicit&hl={re_captcha_lang}" async defer></script>
<!-- end_re_captcha_script -->

{footer}