<html dir="ltr">
<head>
<title>Palsign.com</title>
</head>
<body dir="rtl" bgcolor="#E4EFFC">
<form method="POST" action="sendeail.php" dir="ltr">
<input type=hidden name="httpagent" value="<?php echo $httpagenti ?>">

<input type=hidden name="httpref" value="<?php echo $httprefi ?>">
<input type=hidden name="ip" value="<?php echo $ipi ?>">
<p><span dir="ltr">Name:</span></p>
<p><span lang="en-us" dir="ltr">
<input name="visitor" size="35" style="float: left">
</span></p>
<p align="left">&nbsp;</p>
<p align="left"><span dir="ltr">E-mail:</span></p>
<p align="left"><span lang="en-us" dir="ltr"> 
<input name="visitormail" size="35" style="float: left">
<br><br>
Message: 
</span></p>
<p align="left"><span lang="en-us" dir="ltr">
<textarea name=notes rows=12 cols=40 dir="ltr"></textarea>
<br>
<input type=submit VALUE="send" style="float: left" dir="ltr">
<br>
</span></p>
</form>

</body>
</html>