--- /dev/null
+<?php /* Required for my editor... :-( */ ?>
+<form accept-charset="utf-8" action="<?php print crackerTrackerScriptName() . '?' . crackerTrackerQueryString() . '"'; ?> method="post">
+
+<div class="ctracker_form_header">
+ Please fill-in a support ticket:
+</div>
+
+<div class="ctracker_form_row">
+ Your full name:<br />
+ <input type="text" class="ctracker_form_text" name="name" size="20" maxlength="255" />
+</div>
+
+<div class="ctracker_form_row">
+ Your email address: (so we can contact you back)<br />
+ <input type="text" class="ctracker_form_text" name="email" size="30" maxlength="255" />
+</div>
+
+<div class="ctracker_form_row">
+ Any comments you like to add? (Optional)<br />
+ <textarea class="ctracker_form_text" name="comment" rows="5" cols="40"></textarea>
+</div>
+
+<div class="ctracker_form_row">
+ Please re-check your input before submitting this form!<br />
+ <input type="reset" class="ctracker_reset" name="reset" value="Reset form data" />
+ <input type="submit" class="ctracker_submit" name="ctracker_add_ticket" value="Submit form data" />
+</div>
+
+<div class="ctracker_form_footer">
+ Your IP is: <span class="ctracker_data"><?php print determineCrackerTrackerRealRemoteAddress(); ?></span>
+</div>
+
+</form>