<fieldset>
              <div class="inner-contactbox-form-demo">
                  <div class="contact-row">
                   <div class="contact-col"><span class="required">First Name :*</span></div>
                  <div class="contact-col">[text* Name 30/]</div>
                  
                  </div>
                  <div class="contact-row">
                   <div class="contact-col"><span class="required">Last Name :*</span></div>
                  <div class="contact-col">[text* LastName 30/]</div>
                  
                  </div>
                  <div class="contact-row">
                   <div class="contact-col"><span class="required">Company :*</span></div>
                  <div class="contact-col">[text* Company 30/]</div>
                  
                  </div>
                  <div class="contact-row">
                   <div class="contact-col"><span class="required">Job Title :*</span></div>
                  <div class="contact-col">[text* JobTitle 30/]</div>
                  
                  </div>
                  <div class="contact-row">
                   <div class="contact-col"><span class="required">Phone Number :*</span></div>
                  <div class="contact-col">[text* PhoneNumber 30/]</div>
                  
                  </div>
                  <div class="contact-row">
                   <div class="contact-col"><span class="required">Email Address :*</span></div>
                  <div class="contact-col">[email* EmailAddress 30/]</div>
                  
                  </div>
                  
                  <div class="contact-row">
                   <div class="contact-col"><span class="required">What best describes your business :*</span></div>
                  <div class="contact-col">[select* Whatbestdescribesyourbusiness "Consultant" "Enterprise End User" "Government" "Manufacturing" "Reseller" "Retail" "System Integrator"]</div>
                  
                  </div>
                  <div class="contact-row">
                   <div class="contact-col"><span class="required">Number of Employees :*</span></div>
                  <div class="contact-col">[select* NumberofEmployees "0-100" "101-250" "251-500" "501-1000" "1,000+"]</div>
                  
                  </div>
                  <div class="contact-row">
                   <div class="contact-col"><span class="required">What is the primary issue you are looking to solve? :*</span></div>
                  <div class="contact-col">[select* Whatisthechiefissueyouarelookingtosolve "ITSM" "Svc Desk" "Implementation" "Custom" "Admin" "Other"]</div>
                  
                  </div>
                  <div class="contact-row">
                   <div class="contact-col"><span class="required">Do you have a current ITSM initiative? :*</span></div>
                  <div class="contact-col">[select* DoyouhaveacurrentITSMinitiative "Yes" "No"]</div>
                  
                  </div>
                  <div class="contact-row">
                   <div class="contact-col"><span class="required">Do you have an identified budget for a IT management initiative?:*</span></div>
                  <div class="contact-col">[select* DoyouhaveanidentifiedbudgetforaITmanagementinitiative "Yes" "No"]</div>
                  
                  </div>
                  <div class="contact-row">
                   <div class="contact-col"><span class="required">I am looking to implement a ITSM/ITIL initiative in the next.. :* </span></div>
                  <div class="contact-col">[select* IamlookingtoimplementaITSMITILinitiativeinthenext "30 days" "60-90 days" "6 months" "This year" "Unknown"]</div>
                 
                  </div>
                                
                 
              </div>
            
              <div class="inner-contactbox-submit"> [submit "&nbsp;"]</div>
              </fieldset>