<div class="row">
<div class="small-12 medium-4 columns">
    <label for="first-name" class="screen-reader-text">First name</label>[text* first-name id:first-name placeholder "First name*"]
</div>
<div class="small-12 medium-4 columns">
    <label for="last-name" class="screen-reader-text">Last name</label>[text* last-name id:last-name placeholder "Last name*"]
</div>
<div class="small-12 medium-4 columns">
    <label for="your-email" class="screen-reader-text">Email address</label>[email* your-email id:your-email placeholder "Email address*"]
</div>
</div>
<div class="row">
<div class="small-12 medium-4 columns">
    <label for="your-phone" class="screen-reader-text">Phone number</label>[tel* your-phone id:your-phone placeholder "Phone*"]
</div>
<div class="small-12 medium-4 columns">
    <label for="your-company" class="screen-reader-text">Company</label>[text* your-company id:your-company placeholder "Company*"]
</div>
<div class="small-12 medium-4 columns">
    [select menu-863 include_blank "IT Managed Services" "Security" "Hosted Communications" "Disaster Recovery" "Office 365" "Cloud Infrastructure"]
</div>
</div>
<p class="text-center">[submit "Submit"]</p>