[response]
<div class="contact-left">
<p>Your Email<br />
    [email* your-email] </p>

<p>First Name<br />
    [text* first-name] </p>

<p>Last Name<br />
    [text* last-name] </p>

<p>Phone Number<br />
    [text phone-number] </p>

</div>
<div class="contact-right">

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

[recaptcha]

<p>[submit "Submit"]</p>
</div>

<div class="clearfix"></div>