<form class="send-details-form">
<p class="full-details--header">Send Me Full Details</p>
<div class="input-wrapper">
<div>
<label class="details-label">Company</label>
[text* CompanyName class:details-input]
</div>
<div>
<label class="details-label">Contact Person</label>
[text* Name class:details-input]
</div>
</div>
<div class="input-wrapper-single">
<label class="details-label">Email</label>
[email* Email class:details-input]
</div>
<div class="input-wrapper">
<div>
<label class="details-label">Phone</label>
[tel* Phone minlength:10 maxlength:10 class:details-input]
</div>
<div>
<label class="details-label">Preferred Location</label>
[select* PreferredLocation class:details-dropdown "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>
<div class="input-wrapper-single">
<label class="details-label">Query</label>
[textarea* EnteryourQuery 10x3 class:details-input]
</div>
[dynamichidden Properties "user_favorites"]
[hidden Status "Unqualified"]
[hidden tracking_info]
[submit class:details-submit "Send"]
</form>