<div class="gdlr-shortcode-wrapper gdlr-row-shortcode">

<div class="six columns">
<div class="gdlr-item">
<label> Your Name (required)
[text* name-approval] </label>
<label> Your Email (required)
[email* email-approval] </label>
<label> Your Phone Number (required)
[text* phone-approval] </label>
</div>
</div>

<div class="six columns">
<div class="gdlr-item">
<label class="hide-label"> Your Name (required)</label>
[select* menu-346 "I'm interested In:" "- Purchasing a home" "- Refinancing my home" "- Renewing my mortgage" "- Purchasing an investment property" "- Consolidate debt"]
<label class="hide-label"> Your Email (required)</label>
<label class="hide-label"> Your Phone Number (required)</label>
[select menu-127 "Credit Score:" "- Excellent (700+)" "- Good (640+)" "- Bruised (580+)" "- Other (Not sure)"]
[textarea textarea-421 "Best time to call:"]
</div>
</div>


<div class="twelve columns" id="wpcf7-from">[submit "Send"]</div>

<div class="clear"></div>

</div>