<div class="row">
	<div class="col-md-12"><h4 class="form-title">Book appointment</h4><p class="form-description">It's out pleasure to have a chance to cooperate.</p></div>

	<div class="col-md-12">
		<div class="form-item">[text* your-name placeholder "Name *"]</div>
	</div>
	<div class="col-md-12">
		<div class="form-item">[email* your-email placeholder "Email *"]</div>
	</div>

	<div class="col-md-12">
		<div class="form-item">[select inquiry "Your inquiry about" "General Information Request" "Healthcare Solutions" "Education Solutions" "Partner Relations" "Careers" "Software Licensing"]</div>
	</div>

	<div class="col-md-12">
		<div class="form-submit">
			[submit "Submit"]
		</div>
	</div>
</div>