<div class="form-request-callback">
<h4 class="form-title">Leave your contacts and we will call you.</h4>
<div class="row">
<div class="columns columns-12">[text text-252 placeholder "Your Name"]</div>
</div>
<div class="row">
<div class="columns columns-12">[tel tel-781 placeholder "Your Phone Number eg: 012 345 6789"]</div>
</div>
<div class="row">
<div class="columns columns-12"><small>Just submit your details and we’ll be in touch shortly.</small></div>
</div>
<div class="row">
<div class="columns columns-6">[submit "Request"]</div>
</div>
</div>