meta/lib/meta_web/templates/support/new.html.eex

<h1>New support request</h1>

<%= form_for @request_changeset, Routes.support_path(@conn, :new), fn f -> %>
  <%= if @request_changeset.action do %>
    <div class="alert alert-danger">
      <p>Oops, something went wrong! Please check the errors below.</p>
    </div>
  <% end %>

  <%= text_input f, :name, placeholder: "Name" %>
  <%= error_tag f, :name %>

  <br />

  <%= email_input f, :email, placeholder: "Email" %>
  <%= error_tag f, :email %>

  <br />

  <%= textarea f, :message, placeholder: "Your message" %>
  <%= error_tag f, :message %>

  <br />

  <p>
  Can you answer the following expression to confirm you are
  not a basic robot?

  <br />

  <b><%= @captcha %> = </b>

  <%= text_input f, :captcha, placeholder: "Captcha" %>
  <%= error_tag f, :captcha %>

  </p>


  <div>
    <%= submit "Send" %>
  </div>
<% end %>