<div class="request_callback">
    <p>I would like to discuss:</p>
    <div class="row">
        <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12">
            <div class="input-group">
                [select services_consulting first_as_label "Business Planning" "Audit & Assurance" "Strategic Planning" "Trades & Stocks" "Financial Projections"]
            </div>
        </div>
        <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>
        <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12">
            <div class="input-group">
                [tel* phone placeholder "Phone number"]
            </div>
        </div>
        <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12">
            <div class="input-group">
                <button type="submit" class="button size-lg icon_right">submit <i class="fa fa-chevron-right"></i></button>
            </div>
        </div>
    </div>
</div>