<div class="contact-from">
	<div class="input-group">
		<div class="input-box">
			<strong>First Name</strong>
			[text* first-name]
		</div>
		<div class="input-box">
			<strong>Last Name</strong>
			[text* last-name]
		</div>
	</div>
	<div class="input-group">
		<div class="input-box">
			<strong>Phone</strong>
			[tel your-phone]
		</div>
		<div class="input-box">
			<strong>Email</strong>
			[email* your-email]
		</div>
	</div>
	<div class="input-group">
		<div class="input-box">
			<strong>Event Date</strong>
			[date event-date]
		</div>
		<div class="input-box">
			<strong>Event Venue</strong>
			[text event-venue]
		</div>
	</div>
	<div class="input-box">
		<strong>Event Type</strong>
		[select* Event-Type "Select Event Type" "Celebration" "Corporate" "Social" "Fundraiser"]
	</div>
	<div class="input-box checkbox-box">
		<strong>Bar Budget</strong> 
		[checkbox checkbox-853 use_label_element "$0-$500" "$501-$999" "$1000-$1999" "$2000-$2999" "$3000+"]
	</div>
	<div class="input-group">
		<div class="input-box">
			<strong>Start/End Time <small>(OPTIONAL)</small></strong>
			[date start-end-date]
		</div>
		<div class="input-box">
			<strong>Estimated Guest Count</strong>
			[text estimated-count]
		</div>
	</div>
	<div class="input-box checkbox-box">
		<strong>Bar Type</strong> 
		[checkbox checkbox-853 use_label_element "Liquor, beer, wine and champagne service" "Liquor, beer and wine service" "Beer, wine and champagne service" "Beer and wine service" "Custom or craft cocktail(s)"]
	</div>
	<div class="input-box">
		<strong>Would you like assistance preparing your alcohol shopping list?</strong>
		[text shopping-list]
	</div>
	<div class="input-box">
		<strong>How did you hear about us?</strong>
		[text shopping-list]			
	</div>
	<div class="input-box">
		<strong>Message</strong>
		[textarea your-message]
	</div>
	<div class="submit-box">
		[submit "Submit"]
	</div>
</div>