[text company-name class:suba placeholder "COMPANY NAME"]

[text* contact-name class:suba placeholder "CONTACT NAME"]

[number* your-phone class:digits placeholder "PHONE NUMBER"]

[date* appo-date class:suba placeholder "APPOINTMENT DATE"]

[text time-request class:suba placeholder "TIME REQUEST"]

[file Upload-file class:suba]

[submit class:btn-submit "SUBMIT"]