<div class="grid pixcode--grid">
<div class="grid__item  six-twelfths palm-one-whole">
[text* your-name placeholder "First Name"]
</div>
<div class="grid__item  six-twelfths palm-one-whole">
[text* last-name placeholder "Last Name"]
</div>
</div>
<div class="grid pixcode--grid">
<div class="grid__item  six-twelfths palm-one-whole">
[date* date id:date placeholder "Party Date"]
</div>
<div class="grid__item  six-twelfths palm-one-whole">
[select* time id:time "11:00" "11:30" "12:00" "12:30" "13:00" "13:30" "14:00" "14:30" "15:00" "15:30" "16:00" "16:30" "17:00" "17:30" "18:00" "18:30" "19:00" "19:30" "20:00" "20:30" "21:00" "21:30"]
</div>
</div>
<div class="grid pixcode--grid">
<div class="grid__item  six-twelfths palm-one-whole">
[select* type id:type "SEATED DINNER" "SEATED LUNCH" "COCKTAIL RECEPTION"]
</div>
<div class="grid__item  six-twelfths palm-one-whole">
[number* guests min:10 id:guests placeholder "Number of Guests"]
</div>
</div>
<div class="grid pixcode--grid">
<div class="grid__item  six-twelfths palm-one-whole">
[tel* tel id:tel placeholder "Phone"]
</div>
<div class="grid__item  six-twelfths palm-one-whole">
[email* email id:email placeholder "Email"]
</div>
</div>
[submit "Send Request"]