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<!DOCTYPE html>
<html>
<head>
<link href="http://ajax.googleapis.com/ajax/libs/jqueryui/1.9.2/themes/smoothness/jquery-ui.min.css" rel="stylesheet" type="text/css" />
<script src="http://ajax.googleapis.com/ajax/libs/jquery/1.9.1/jquery.min.js"></script>
<script src="http://ajax.googleapis.com/ajax/libs/jqueryui/1.9.2/jquery-ui.min.js"></script>
<meta charset=utf-8 />
<title>JS Bin</title>
</head>
<body>
  <table cellpadding='5' cellspacing='5' class='forceCenter' width='50%'>
    <tbody>
        <tr>
            <th>First Name
                <label class="errorStar fRight">*</label>
            </th>
            <td><input type='text' class='allW' /></td>
        </tr>
        <tr>
            <th>Last Name
                <label class="errorStar fRight">*</label>
            </th>
            <td><input type='text' class='allW' /></td>
        </tr>
        <tr>
            <th>Company Name
                <label class="errorStar fRight">*</label>
            </th>
            <td><input type='text' class='allW' /></td>
        </tr>
        <tr>
            <th>Email
                <label class="errorStar fRight">*</label>
            </th>
            <td><input type='text' class='allW' /></td>
        </tr>
        <tr>
            <th>Subject
                <label class="errorStar fRight">*</label>
            </th>
            <td><input type='text' class='allW' /></td>
        </tr>
        <tr>
            <th valign="top">Comments
                <label class="errorStar fRight">*</label>
            </th>
            <td><textarea class='allW'></textarea></td>
        </tr>
        <tr>
            <td colspan='2' class="text-right">
                <label class="errorVal padL padR sentVal"><span class='glyphicon glyphicon-send smIcon padR'></span>Thank you. Your request was received.</label>&nbsp;&nbsp;
                <label class="errorVal padL padR emptyVal"><span class='Error smIcon padR'></span>Please fill in all inputs above.</label>&nbsp;&nbsp;
                <input type='submit' value='Send' class='greenBtn sendSupport' />
            </td>
        </tr>
    </tbody>
</table>
</body>
</html>
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