<div class="row clearfix">
<div class="col-lg-6 col-md-6 col-sm-12 big-column">
<div class="form-group">[text* your-name placeholder "Tu Nombre *"]</div>
<div class="form-group">[email* your-email placeholder "Email *"]</div>
<div class="form-group">
<div class="select-box">[select menu-114 class:wide include_blank "Policing & Crime" "Housing & Land" "Health & Medical" "Tourism & Travel"]</div>
</div>
</div>
<div class="col-lg-6 col-md-6 col-sm-12 big-column">
<div class="form-group">[textarea your-message placeholder "Tu pregunta ..."]</div>
</div>
<div class="col-lg-12 col-md-12 col-sm-12 big-column">
<div class="form-group message-btn">[submit class:theme-btn "Envia tu Pregunta"]</div>
</div>
</div>