<div class="clearfix">
<label for="your-name">Your Name*</label>
[text* your-name id:your-name]</div>
<div class="clearfix">
<label for="your-company">Your Company*</label>
[text* your-company id:your-company]</div>
<div class="clearfix">
<label for="your-email">Your Email*</label>
[email* your-email id:your-email]</div>
<div class="clearfix">
<label for="your-phone">Your Phone*</label>
[tel* your-phone id:your-phone]</div>
<div class="clearfix">
<label for="referred-company-name">Referred Company Name*</label>
[text* referred company name id:referred-company-name]</div>
<div class="clearfix">
<label for="main-contact">Main Contact Name*</label>
[text* main-contact id:main-contact]</div>
<div class="clearfix">
<label for="contact-title">Contact Title*</label>
[email* contact-title id:contact-title]</div>
<div class="clearfix">
<label for="contact-email">Contact Email*</label>
[email* contact-email id:contact-email]</div>
<div class="clearfix">
<label for="contact-phone">Contact Phone*</label>
[tel* contact-phone id:contact-phone]</div>
<div class="clearfix">
<label for="your-message">Message*</label>
[textarea* your-message id:your-message]</div>
<p class="text-center">[submit "Submit"]</p>