<div class="container-fluid">
    <div class="row">
        <div class="col-md-2 col-md-offset-1">
            [text* your-name class:form-control placeholder "Name"]
        </div>
        <div class="col-md-2">
            [email* your-email class:form-control placeholder "E-mail Addres"]
        </div>
        <div class="col-md-2">
            [number phonenumber class:form-control min:0 placeholder "Phone Number"]
        </div>
        <div class="col-md-2">
            [text* your-company class:form-control placeholder "Company"]
        </div>
        <div class="col-md-2">    
            [select department class:form-control "UPI Main Office" "Warehouse Operations" "Shipping &amp; Receiving" "Technical Support &amp; Documentation" "Quality Assurance &amp; Quality Control" "Regulatory Affairs" "Accounting " "Accounts Payable" "Accounts Receivable" "Purchasing Department" "Customer Service Team" "Sales Department" "Inside Sales Desk"]
        </div>
    </div>
    <div class="row" style="margin-top: 10px;">
        <div class="col-md-10 col-md-offset-1" >
            [textarea message class:form-control class:form-message placeholder "Message"]
        </div>
    </div>
    <div class="row">
        <div class="col-md-5 col-md-offset-4">[recaptcha]</div>
        <div class="col-md-3">[submit class:btn class:btn--form "SEND"]</div>
    </div>
</div>