<form action="" method="post" id="frmSendMessage" class="form pj-form">
	<p><label><input type="checkbox" value="1" name="dialog_confirm" id="dialog_confirm" /> <?php __('ResConfirmationText'); ?></label></p><br />
	<p>
		<label class="title"><?php __('lblSendTo');?></label>
		<input type="text" name="email" class="pj-form-field" style="width: 300px" value="<?php echo $tpl['response']['email'];?>"/>
	</p>
	<p>
		<label class="title"><?php __('lblSubject');?></label>
		<input type="text" name="subject" class="pj-form-field" style="width: 300px" value="<?php echo $tpl['response']['subject'];?>"/>
	</p>
	<p><textarea id="mceEditor" name="message" class="pj-form-field pj-form-field-readonly mceEditor" style="width: 470px; height: 310px; resize: none" readonly="readonly"><?php echo stripslashes($tpl['response']['body']);?></textarea></p>
</form>