<div class="request_callback">
<div class="row">
<div class="col-lg-6 col-md-6 col-sm-6 col-xs-12">
<div class="input-group">
[text* text-name placeholder akismet:author "First name *"]
</div>
<div class="input-group">
[email* email placeholder akismet:author_email "E-mail *"]
</div>
<div class="input-group">
[tel* phone placeholder "Phone *"]
</div>
</div>
<div class="col-lg-6 col-md-6 col-sm-6 col-xs-12">
<div class="input-group">
[textarea* message placeholder "Your Message *"]
</div>
<div class="input-group">
<button type="submit" class="button size-md icon_right">submit <i class="fa fa-chevron-right"></i></button>
</div>
</div>
</div>
</div>