<br />
<p>Name<br />
    [text* your-name] </p>

<p>Email<br />
    [email* your-email] </p>

<p>Address<br />
    [text Address] </p>
<p>Phone<br />
   [text* phone] </p>
<p>Home Square Footage<br />
    [text HomeSquareFootage]</p>

<p>Message<br />
    [textarea your-message] </p>


<p><b>How did you hear about us? </b></p>
<p>[checkbox hearaboutus "Google" "Facebook" "Twitter" "Friend/Family" "Other"]</p>

<p>Input this code below:  [captchac captcha-170] </p>
[captchar captcha-170 4/4]

<p>[submit class:btn class:btn-success]</p>