<META HTTP-EQUIV="Content-type" CONTENT="text/html; charset=UTF-8"/>

<form action="https://webto.salesforce.com/servlet/servlet.WebToCase?encoding=UTF-8" method="POST">

  <input type="hidden" name="orgid" value="00D300000000Swd"/>
  <input type="hidden" name="retURL" value="http://support.companioncorp.com"/>

<input type="hidden" name="debug" value="1" />
<input type="hidden" name="debugEmail" value="mvoseipka@companioncorp.com"/>

  <label for="name">Name:</label> <br /><input  id="name" maxlength="80" name="name" size="30" type="text" /><br /><br />

  <label for="email">Email:</label> <br /><input  id="email" maxlength="80" name="email" size="30" type="text" /><br /><br />

  <label for="phone">Phone:</label> <br /><input  id="phone" maxlength="40" name="phone" size="30" type="text" /><br /><br />

  <label for="subject">Subject:</label> <br /><input  id="subject" maxlength="80" name="subject" size="30x2030" type="text" /><br /><br />

  <label for="description">Description:</label> <br /><textarea name="description" size="4060"></textarea><br /><br />

  <input type="submit" name="submit"/>

</form>