<form action="contact-us" method="post">
<p>
<label for="a">Your name ~</label> <input type="text" name="name" id="a" /><span class="pop"></span><br />
<label for="b">Your email address <em>(optional)</em> ~</label> <input type="text" name="email" id="b" /><span class="pop"></span><br />
<label for="c">Your phone number ~</label> <input type="text" name="phone" id="c" /><span class="pop"></span><br />
<label for="d">Residential ~</label> <input id="d" type="radio" name="type" value="Residential" checked="checked" /><br />
<label for="e">Industrial ~</label> <input id="e" type="radio" name="type" value="Industrial" /><br />
<label for="f">Description of the work you would like us to do ~</label><br />
<input type="hidden" name="a" value="a" />
<textarea name="mess" id="f" ></textarea><span id="text" class="pop"></span>
</p>
<p>
<button type="submit">Contact Us</button>
</p>
</form>