<img src="https://laser-cnc.co.il/wp-content/uploads/2017/06/ILENDING-PAGE_LAZER_19.06.17.png" alt="" />

<hr style="border-color: #999999; border-width: 1px;" />

<form action="" method="post"><input name="action" type="hidden" value="pojo_form_contact_submit" />
<input name="form_id" type="hidden" value="566" />
<input name="_wp_http_referer" type="hidden" value="/wp-admin/post.php" />
<label for="form-field-1-1">שם</label>
<input id="form-field-1-1" name="form_field_1" type="text" placeholder="שם" aria-required="true" />
<label for="form-field-1-2">דוא״ל</label>
<input id="form-field-1-2" name="form_field_2" type="email" placeholder="דוא״ל" />
<label for="form-field-1-3">טלפון</label>
<input id="form-field-1-3" title="רק מספרי טלפון מותרים." name="form_field_3" pattern="[0-9.+-()*#]+" type="tel" placeholder="טלפון" aria-required="true" />
<button style="background-color: rgba(184,0,0,1); border-color: #b80000; color: #ffffff;" type="submit">שלח</button></form>

<hr style="border-color: #999999; border-width: 1px;" />