<div class="hazel-request-quote f1">
<div class="rq-name">
<p>Your Name<br />
    [text* your-name] </p>
</div>

<div class="rq-email">
<p>E-Mail Address<br />
    [email* your-email] </p>
</div>

<div class="rq-phone">
<p>Phone Number<br />
    [text* phone] </p>
</div>

<div class="rq-address">
<p>Address Line 1<br />
    [text* street1] </p>
</div>

<div class="rq-address2">
<p>Address Line 2<br />
    [text* street2] </p>
</div>

<div class="rq-city">
<p>City<br />
    [text* city] </p>
</div>
</div>

<div class="hazel-request-quote f2">
<div class="rq-website">
<p>Your Website<br />
    [text* website] </p>
</div>

<div class="rq-website-insp">
<p>Inspiration Website<br />
    [text* inwebsite] </p>
</div>

<div class="rq-services">
<p>Services<br>
[checkbox checkbox-393 use_label_element  "Unique Design" "Automated Backups" "24/7 Security Monitoring" "Performance Optimization" "Cloud Hosting" "Server Migration" "Backend WebSite(CMS)" "Backend Training"]</p>
</div>

<div class="rq-budget-time">
<p>Project Budget<br />
[select menu-278 "$1,000 - $2,500" "$2,500 - $5,000" "$5,000 - $7,500" "$7,500 - $10,000" "$10,000 - $15,000"] </p>

<p>Project Timeframe<br />
[select menu-615 "2-4 Weeks" "2 Months" "4 Months" "No Timeframe"] </p>
</div>
</div>

<div class="hazel-request-quote f3">
<div class="rq-desc">
<p>Project Description<br />
    [textarea your-message] </p>
</div>

<div class="rq-files">
<p>Project Files<br />
[file file-226] </p>
</div>

<div class="bt-contact">
   <a class="btn-contact-left"  href="javascript:;">[submit "Submit Request"]</a>
</div>
</div>