{NAME}, submitted the following information:

Contact Reason: {REASON}

Comments:
{COMMENTS}

--------------------
Contact Details:

Company  : {COMPANY}
Location : {LOCATION}
Url      : {URL}
Email    : {EMAIL}
{IM}     : {IMNO}

--------------------
User Info:

Time  : {TIME}
IP    : {IP}
Agent : {AGENT}
