<div class="get_free">
[select items "Pets Control" "Pets Control" "Pets Control"]
<label>[text* your-name placeholder "Name*"] </label>
<label>[text* placeholder "Zip-Code"] </label>
<div class="submit_estimate">
[submit "Submit"]
</div>
</div>
<div class="control-acceptance">
[acceptance acceptance-144] I agree that my submitted data is being collected and stored. [/acceptance]
</div>