<form name="leaveMessageForm" method="post" action="">
    <input type="hidden" name="style" value="{{page.style}}"/>
    <input type="hidden" name="info" value="{{info}}"/>
    <input type="hidden" name="referrer" value="{{referrer}}"/>
    {{#unless groups}}{{#if groupId}}<input type="hidden" name="group" value="{{groupId}}"/>{{/if}}{{/unless}}

    <div class="errors"></div>

    <table cellspacing="1" cellpadding="5" border="0" class="form">
        <tr>
            <td><strong>{{l10n "Your email"}}:</strong></td>
            <td><input type="text" name="email" size="50" value="{{email}}" class="username"/></td>
        </tr>
        <tr>
            <td><strong>{{l10n "Your name"}}:</strong></td>
            <td><input type="text" name="name" size="50" value="{{name}}" class="username"/></td>
        </tr>
    {{#if groups}}
        <tr>
            <td class="text"><strong>{{l10n "Choose Department:"}}</strong></td>
            <td>
                <select name="group" style="min-width:200px;">
                    {{#each groups}}
                        <option value="{{this.id}}" {{#if this.selected}}selected="selected"{{/if}}>{{this.name}}</option>
                    {{/each}}
                </select>
            </td>
        </tr>
        <tr>
            <td class="text"><strong>{{l10n "Department description:"}}</strong></td>
            <td class="text" id="group-description">
                {{#each groups}}{{#if this.selected}}{{this.description}}{{/if}}{{/each}}
            </td>
        </tr>
    {{/if}}
        <tr>
            <td><strong>{{l10n "Message"}}:</strong></td>
            <td valign="top">
                <textarea name="message" tabindex="0" cols="40" rows="5">{{message}}</textarea>
            </td>
        </tr>
    {{#if showCaptcha}}
        <tr>
            <td><img id="captcha-img" src="captcha"/></td>
            <td><input type="text" name="captcha" size="50" maxlength="15" value="" class="username"/></td>
        </tr>
    {{/if}}
    </table>
    <a href="javascript:void(0);" class="but" id="send-message">{{l10n "Send"}}</a>
    <div class="clear">&nbsp;</div>
</form>
<div id="ajax-loader"><img src="{{page.stylePath}}/images/ajax-loader.gif" alt="Loading..." /></div>