[bigcoder]

This code is from your website and is edited and should work

<!--  ----------------------------------------------------------------------  -->
<!--  NOTE: These fields are optional debugging elements. Please uncomment    -->
<!--  these lines if you wish to test in debug mode.                          -->
<!--  <input type="hidden" name="debug" value=1>                              -->
<!--  <input type="hidden" name="debugEmail" value="shell@shellblack.com">    -->
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<label for="first_name"&#160>First Name&#160</label><input  id="first_name" maxlength="40" name="first_name" size="23" type="text" /><br>
<br>
<label for="last_name">Last Name&#160</label><input  id="last_name" maxlength="80" name="last_name" size="23" type="text" /><br><br>

<label for="email"&#160>Email&#160</label><input  id="email" maxlength="80" name="email" size="29" type="text" /><br><br>

<label for="phone"&#160>Phone&#160</label><input  id="phone" maxlength="40" name="phone" size="28" type="text" /><br><br>

<label for="mobile">Mobile&#160</label><input  id="mobile" maxlength="40" name="mobile" size="28" type="text" /><br><br>

<label for="street">Address&#160</label><textarea name="street"></textarea><br><br>

<label for="city">City&#160</label><input  id="city" maxlength="40" name="city" size="31" type="text" /><br><br>

<label for="state"&#160>State/Province&#160</label><input  id="state" maxlength="20" name="state" size="20" type="text" /><br><br>

<label for="zip">Zip&#160</label><input  id="zip" maxlength="20" name="zip" size="32" type="text" /><br><br>

<label for="description">Description&#160</label><textarea name="description"></textarea><br><br>

<br>

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