diff --git a/templates/contact-us.html b/templates/contact-us.html
index cbc51eaa2f82de05937eb893a37d6f8bc0915560..2e2631bcf1492643db06582ec9ff9774bb348ada 100644
--- a/templates/contact-us.html
+++ b/templates/contact-us.html
@@ -1,6 +1,29 @@
 {% extends "main.html" %}
-{% block title %}Map{% endblock %}
+{% block title %}Contact{% endblock %}
 {% block mainBlock %}
-<header> Contact <header> 
-  <p> tact info.</p>
+<header> Contact Us </header>
+<p>text about contact info.</p>
+<table>
+  <tr>
+    <td><label for="UserName">Name:</label></td>
+    <td><input id="UserName" type="text" name="UserName"></td>
+  </tr>
+  <tr>
+    <td><label for="UserEmailAddress">Email Address:</label></td>
+    <td><input id="UserEmailAddress" type="text" name="UserEmailAddress"></td>
+  </tr>
+  <tr>
+    <td><label for="UserSubject">Subject:</label></td>
+    <td><div><textarea id="UserSubject" name="UserSubject"></textarea></div></td>
+  </tr>
+  <tr>
+    <td><label for="UserLocation">Location(if not applicable respond N/A):</label></td>
+    <td><input id="UserLocation" type="text" name="UserLocation"></td>
+  </tr>
+  <tr>
+    <td><label for="UserIssue">Description:</label></td>
+    <td><div><textarea id="UserIssue" name="UserIssue"></textarea></div></td>
+  </tr>
+</table>
+<input type="submit">
 {% endblock %}