<style type="text/css">
.form_2{ float:right; width:725px; margin-top:10px;}
.item_style3{border: 1px solid #954401;clear: both;float: none;overflow: hidden;padding: 10px 0;}
.item_style3 h3{clear: both;color:#990000;display: block;float: none;font-size: 14px;font-weight: bold;height: 20px;padding-left: 15px;}
.table_ul1 {clear: both;display: block;float: none;list-style: none outside none;padding: 10px 0 20px 10px}
.table_ul1 li {clear: both;float: none; padding:4px auto; margin:5px 0;}
.table_ul1 li select{font-size:11px;}
.table_ul1 li span {color: #666666;display: block;float: left;font-size: 11px;font-weight: normal;margin-right: 10px;padding-top: 5px;text-align: right;width: 100px;}
.table_ul1 input, .table_ul1 select, .table_ul1 textarea {float: left;margin-right: 4px;margin-top: 3px;padding-bottom: 2px;}
.input_1 {border: 1px solid #CCCCCC;color: #333333;font-size: 12px;}
.message_normal {color: #999999;display: block;float: left;font-size: 11px;font-style: normal;margin-right: 10px;padding-left: 5px;padding-top: 5px;text-align: left;}
.putIn_box {clear: both;float: none;padding: 10px 0;text-align: center;}
.submit_3 {background: url("https://www.beststoreitems.com/catalog/template/beststoreitems/image/submit.gif") repeat scroll 0 0 transparent;border-style: none;border-width: 0;color: #FFFFFF;cursor: pointer;font-size: 14px;font-weight: bold;height: 26px;width: 80px;}
</style>
<div class="form_2">
    <form  id="formMail" name="formMail" method="post" action="/index.php?controller=buyer_talks&action=addfeedback">
    <input type="hidden" name="user_id" value="<?php echo $user_id;?>" />
      <div class="item_style3">
        <h3>Send us your feedback and suggestion</h3>
        <ul class="table_ul1">
          <li class="clearfix"><span>Name:</span>
          <?php if($user_id>0){?>
            <input type="text" size="50" value="<?php echo $user_name;?>" class="input_1" name="user_name" id="user_name">
          <?php }else {?>
          	<input type="text" size="50" value="" class="input_1" name="user_name" id="user_name">
          <?php }?>
          </li>
          <li class="clearfix"><span>Country:</span>
            <select name="country_id">
				<?php foreach ($countries as $country) { ?>
				<?php if ($country['country_id'] == $country_id) { ?>
					<option value="<?php echo $country['country_id']; ?>" SELECTED><?php echo $country['name']; ?></option>
				<?php } else { ?>
					<option value="<?php echo $country['country_id']; ?>"><?php echo $country['name']; ?></option>
				<?php } ?>
				<?php } ?>
            </select>
            </li>
            <li class="clearfix"><span>Suggestion:</span>
            <textarea class="input_1" rows="8" cols="50" name="comment" id="comment"></textarea>
          </li>
        </ul>
        <div class="putIn_box">
          <input type="button" class="submit_3" onclick="postMail()" value="" name="Submit4">
        </div>
      </div>
    </form>
  </div>
  <script type="text/javascript">
  function postMail(){
  	var user_name = document.getElementById('user_name').value;
  	var comment = document.getElementById('comment').value;
  	if(user_name == '')
  	{
  		alert('user_name is not empty!');
  		return false;
  	}
  	if(comment == '')
  	{
  		alert('comment is not empty!');
  		return false;
  	}else{
  		document.getElementById('formMail').submit();
  	}
  }
  </script>