<div class="gdlr-core-input-wrap gdlr-core-large gdlr-core-full-width gdlr-core-with-column gdlr-core-no-border" >
<div class="gdlr-core-column-60">[text* your-name placeholder "Full Name*"]</div>
<div class="clear"></div>
<div class="gdlr-core-column-30">[email* your-email placeholder "Email*"]</div>
<div class="gdlr-core-column-30">[text* your-address placeholder "Address*"]</div>
<div class="clear"></div>
<div class="gdlr-core-column-30">[text* your-company placeholder "Company*"]</div>
<div class="gdlr-core-column-30">[tel* your-phone placeholder "Phone*"]</div>
<div class="clear"></div>
<div class="gdlr-core-column-30">[text* your-area placeholder "Areas Of Interest*"]</div>
<div class="gdlr-core-column-30">[text* your-budget placeholder "Project Budget*"]</div>
<div class="clear"></div>
<div class="gdlr-core-column-30">[date* your-date placeholder "Requested Completion Date*"]</div>
<div class="gdlr-core-column-30">[text your-refer placeholder "Referred By"]</div>
<div class="clear"></div>
<div class="gdlr-core-column-60">[textarea* your-message placeholder "Tell us about your project*"]</div>
<div class="clear"></div>
<div class="gdlr-core-column-60 gdlr-core-left-align">[submit class:gdlr-core-full "Submit Now"]</div>
</div>