Snipplet call issue?

<h1>Contact Hawthorn Grill</h1>
Please use the contact form below for your inquiries.<br />
*<u>Attention:</u> We do not accept link exchanges or SEO service requests. 
Do not submit these inquiries.<br /><br />
[+validationmessage+]
<form method="post" action="[(base_url)][~5~]">
    <input type="hidden" name="formid" value="feedbackForm" />
    
    <p><label accesskey="n" for="Name">Your Name</label>
    <input type="text" name="Name" maxlength="60" eform="Your Name::1:Expected at least two words:#REGEX /^\w+\s\w+/i" /></p>

    <p><label accesskey="e" for="email">Your Email Address</label>
    <input type="text" name="email" size="40" maxlength="40" eform="Your Email Address:email:1" /></p>
    
    <p><label accesskey="s" for="department">Subject</label>
    <select name="department">
        <option value="1">Question</option>
        <option value="2">Comment</option>
        <option value="3">Feedback</option>
        <option value="4">Other</option>
    </select></p>
    
    <p><label accesskey="c" for="comments">Comments</label>
    <textarea cols="40" rows="10" name="comments" eform="Comments:html:1"></textarea></p>

    <p>
    Please enter the     anti spam code below:<br />
    <img src="[+verimageurl+]" alt="verification code" border="1"/>
    </p>
    <p>
    <label accesskey="c" for="vericode">code</label>
    <input type="text" name="vericode" size="20" />
    </p>
    
    <p><input type="submit" name="submit" value="Send Feedback"></p>
</form>

p>This is a response sent by [+name+] using the feedback form on the website. The details of the message follow below:</p>
<table>
<tr valign="top"><td>Name:</td><td>[+name+]</td></tr>
<tr valign="top"><td>Email:</td><td>[+email+]</td></tr>
<tr valign="top"><td>Comments:</td><td>[+comments+]</td></tr>
</table>
<p>You can use this link to reply: <a href="mailto:[+email+]?subject=RE:[+subject+]">[+email+]</a></p>

<h3>Thank you for your feedback</h3>
<p>We appreciate your time and will respond in a timely manner.</p>
<p>Below is a copy of your message:</p>
<table>
<tr><td>Your name:</td><td>[+name+]</td></tr>
<tr><td>Your email address</td><td>[+email+]</td></tr>
<tr valign="top"><td>Your comments</td><td>[+comments+]</td></tr>
</table>
<p><a href="[(base_url)]">Go to homepage</a> or <a href="[(base_url)][~5~]">Send another inquiry</a>.</p>

[!eForm? &formid=`feedbackForm` &to=`[email protected]` &tpl=`eFeedBackForm` &report=`eFeedBackReport` &thankyou=`eFeedBackThanks` &mailselector=`department` &vericode=`1` &subject=`Web site contact form`!]