<div class="Contact_Box">
<div class="input">
<div class="left">
<b>Name:</b>
<b>Contact Number:</b>
<b>Subject:</b>
<b>Contact Email:</b>
<b>Copy Email:</b>
</div>
<div class="right">
<input title="Please type your first and last name." class="input_box form-control <?php
$TierTwo->input_error('namebox');
?>
" type='text' name="namebox" id="namebox" onblur="setCookie('namebox',document.getElementById('namebox').value,365)">
<input title="Contact number field should only contain numbers. example: 8657778771" class="input_box form-control <?php
$TierTwo->input_error('numberbox');
?>
" type='text' name='numberbox' id="Contact_Number" onblur="this.value = cleanContactNumber(this.value); setCookie('Contact_Number',document.getElementById('Contact_Number').value,365);">
<input title="Please type any subject." class="input_box form-control <?php
$TierTwo->input_error('textboxSubject');
?>
" type='text' name='textboxSubject' id="textboxSubject" onblur="setCookie('textboxSubject',document.getElementById('textboxSubject').value,365)">
<input title="Please type your email address. Only one email address is allowed. example: someone@uscellular.com" class="input_box form-control <?php
$TierTwo->input_error('emailbox');
?>
" type='text' name='emailbox' id="Email" onblur="this.value = cleanEmail( this.value ); setCookie('Email',document.getElementById('Email').value,365)">
<input title="Separate each email address with a comma." class="input_box form-control <?php
