[%# ***** BEGIN LICENSE BLOCK *****
  # Version: MPL 1.1
  #
  # The contents of this file are subject to the Mozilla Public License Version
  # 1.1 (the "License"); you may not use this file except in compliance with
  # the License. You may obtain a copy of the License at
  # http://www.mozilla.org/MPL/
  #
  # Software distributed under the License is distributed on an "AS IS" basis,
  # WITHOUT WARRANTY OF ANY KIND, either express or implied. See the License
  # for the specific language governing rights and limitations under the
  # License.
  #
  # The Original Code is the Hendrix Feedback System.
  #
  # The Initial Developer of the Original Code is
  # Gervase Markham.
  # Portions created by the Initial Developer are Copyright (C) 2004
  # the Initial Developer. All Rights Reserved.
  #
  # Contributor(s):
  #
  # The Initial Developer wrote this software to the Glory of God.
  # ***** END LICENSE BLOCK ***** %]
Name:    [% form.name %]
[% IF form.email %]
Email:   [% form.email FILTER email %]
[% END %]
Product: [% form.product %]
Summary: [% form.subject %]

Comments: 
[%+ form.comments %]

[% IF form.useragent %]
Browser Details: [% form.useragent %]
[% END %]