<div class="input-filled">[text* company-name placeholder "Company name"]</div>
<div class="input-filled">[text* your-phone placeholder "Mobile number"]</div>
<div class="input-filled">[email* your-email placeholder "Email address"]</div>
<div class="input-filled"><button type="submit" class="wpcf7-submit btn btn-default">Appionment<i class="fac fac-angle-right space-left"></i></button></div>