<p><strong>Name:</strong> (required)
    [text* your-name] </p>

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

<p><strong>Number:</strong>
    [tel your-number] </p>

<p><strong>City:</strong> (required)
    [text* your-city] </p>

<p><strong>State:</strong> (required)
    [text* your-state] </p>

<p><strong>Comment:</strong>
    [textarea your-message 40x3] </p>

[cf7sr-simple-recaptcha]

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