<p>First Name (required)<br />
     [text* your-firstname ] </p>

<p>Last Name (required)<br />
    [text* your-lastname ] </p>

<p>Email (required)<br />
    [email* your-email] </p>

<p>Message<br />
    [textarea your-message] </p>

[submit class:btn class:btn-default "SEND REQUEST"]