<div class="row name">
<div class="col-md-5 col-sm-5">
<label>Last Name</label><br/>
    [text lastname]
</div>
<div class="col-md-2 col-sm-2"></div>
<div class="col-md-5 col-sm-5">
<label>First Name</label><br/>
    [text firstname]
</div>
</div>
<div class="row email">
<div class="col-md-12 col-sm-12">
<label>Phone*</label><br/>
[tel* telephone]
</div>
</div>
<div class="row email">
<div class="col-md-12 col-sm-12">
<label>Email Address*</label><br/>
    [email* email]
</div>
</div>

<div class="row message">
<div class="col-md-12 col-sm-12">
<label>Message</label>
   [textarea message 109x3]
</div>
</div>
<div class="row howdid">
<div class="col-md-12 col-sm-12">
<label>How did you hear about us?</label><br/>
  [select menu-595 multiple include_blank "Adverisement" "FM Redio" "TV" "Friends"]
</div>
</div>
<div class="row submit">
<div class="col-md-12 col-sm-12">
[submit class:submitBtn]
</div>
</div>