<div class="request_callback_5">
    <div class="row">
        <div class="col-xs-12">
            <div class="input-group">
                [text* text-name placeholder akismet:author "First name"]
            </div>
        </div>
        <div class="col-xs-12">
            <div class="input-group">
                [select services_consulting first_as_label "Mobility Strategy" "Web & App Development" "Consultancy" "Business Solution" "IOT & Analytics" "Omni-Channel Commerce" "Cyber Security Services" "Cloud Services"]
            </div>
        </div>
        <div class="col-xs-12">
            <div class="input-group">
                [tel* phone placeholder "Phone number"]
            </div>
        </div>
        <div class="col-xs-12">
            <div class="input-group">
                [file file-37 limit:10000000 id:file-37]
            </div>
        </div>
        <div class="col-xs-12">
            <div class="input-group">
                [recaptcha id:recaptcha]
            </div>
        </div>
        <div class="col-xs-12">
            <div class="input-group">
                <button type="submit" class="button theme_style_3 size-lg icon_right">SUBMIT <i class="fa fa-chevron-right"></i></button>
            </div>
        </div>
    </div>
</div>