--- /dev/null
+<p>
+ Move the marker to the correct position and<br/>
+ describe the problem in the box below:
+</p>
+<form action="#">
+ <input type="hidden" name="lon">
+ <input type="hidden" name="lat">
+ <textarea name="comment" cols="40" rows="10"></textarea>
+ <br/>
+ <input type="submit" name="add" value="Add Note" id="note-add">
+</form>