<div class="row"><div class="col-md-12">[text* text-71 placeholder "Your Name*"]</div><div class="col-md-12">[select menu-774 class:selectmenu "Solution" "Solution One" "Solution Two" "Solution Three"]</div><div class="col-md-12"><div class="row"><div class="col-lg-6 col-md-12 col-sm-12 col-xs-12">[text text-72 placeholder "Phone"]</div><div class="col-lg-6 col-md-12 col-sm-12 col-xs-12">[email* email-256 placeholder "Email*"]</div></div></div><div class="col-md-12">[textarea textarea-516 placeholder "Write Your Needs..."]</div><div class="col-md-12">[submit class:thm-btn class:yellow-bg "Submit Now"]</div></div>