<div class="left_field">
<p>NAME *<br />
    [text* your-name] </p>
<p>PHONE *<br />
    [text* your-phone] </p>
</div>
<div class="right_field">
<p>EMAIL *<br />
    [email* your-email] </p>
<p>SUBJECT<br />
    [text your-subject] </p>
</div>
<div class="message_field">
<p>HOW CAN I HELP?<br />
    [textarea your-message] </p>
<p>[submit "Send Message"]</p>
</div>