<form class="contact-form">
 <div class="contact-name contact-input-div">
 [text* Yourname class:contact-input placeholder "Your Name"]
 </div>
 <div class="contact-phone contact-input-div">
 [tel* Phone class:contact-input minlength:10 maxlength:10 placeholder "Phone"]
 </div>
 <div class="contact-email contact-input-div">
 [email* Email class:contact-input placeholder "Email"]
 </div>
 <div class="contact-company contact-input-div">
  [text* Company class:contact-input placeholder "Company"]  
 </div>
 <div class="contact-input-div">
[select* PreferredLocation class:contact-select "Select Location" "Seshadripuram" "Hennur" "Peenya Industrial Area" "Yeshwantpur" "Sanjeevini Nagar" "HBR layout" "Hebbal" "Jalahalli West" "Jalahalli East" "Sadashivanagar" "KH Road" "Silk Board" "Adugodi" "Bellandur" "Bommasandra" "Bommanahalli" "HSR Layout" "Basavanagudi" "Lal Bagh Road" "Electronic City" "Banashankari" "Bannerghatta Road" "BTM Layout" "JP Nagar" "Jayanagar" "Hosur Road" "Koramangala" "Madiwala" "MG Road" "Dickenson Road" "Museum Road" "Residency Road" "Infantry Road" "Cunningham Road" "Ulsoor" "Victoria Layout" "Murphy Road" "Richmond Road" "Brigade Road" "Basaveshwara Nagar" "BEML layout" "Kengeri" "Magadi Road" "Mathikere" "Mysore Road" "Peenya" "Raja Rajeshwari Nagar" "Rajajinagar" "Vijayanagar" "Sarjapur Road" "CV Raman Nagar" "Old Airport Road" "Outer Ring Road" "Marathahalli" "Brookefield" "Indiranagar" "Domlur" "Banaswadi" "Whitefield"]
</div>
<div class="contact-query">
[textarea* Query 10x3 class:contact-input placeholder "Query"]
</div>
[hidden Status "Unqualified"]
[submit class:contact-submit "Submit"]
</form>