{{include file="field_textarea.tpl" field=$freetext}}
{{include file="field_checkbox.tpl" field=$linkglobalsupport}}
{{include file="field_checkbox.tpl" field=$linklocalsupport}}
{{include file="field_input.tpl" field=$localsupportname}}

<div class="submit"><input type="submit" name="page_site" value="{{$submit}}" /></div>