<div class="sc_form sc_form_default">
<h3 class="sc_item_title sc_form_title sc_align_center sc_item_title_style_default sc_item_title_tag"><span class="sc_item_title_text">Submit a request</span></h3>

<div class="sc_form_details trx_addons_columns_wrap">

   <div class="trx_addons_column-1_2">
        <label class="sc_form_field">[text* your-name placeholder "Name*"]</label>
   </div>

   <div class="trx_addons_column-1_2">
        <label class="sc_form_field">[email* your-email placeholder "Email*"]</label>
   </div>

</div>

<label class="sc_form_field">[textarea* your-message placeholder "Message*"]</label>

<div class="sc_form_field sc_form_field_button sc_form_field_submit">
[submit "Submit"]
</div>
		
</div>