  <div class="row">
            	<div class="col-sm-7">
                    <div class="panel panel-default">
                        <div class="panel-heading">Please fill in the below details:</div>
                        <div class="panel-body">
                            <form class="form-horizontal" role="form" autocomplete="off" action="">
                                <div class="form-group">
                                    <label class="control-label col-sm-3" for="Name">
                                        <span class="hidden-xs">Name: <b>*</b></span>
                                        <span class="visible-xs">First Name: <b>*</b></span>
                                    </label>
                                    <div class="col-sm-9">
                                        <div class="row">
                                            <div class="col-sm-6">
                                                <div class="input-group">
                                                    <span class="input-group-addon"><span class="glyphicon glyphicon-user"></span></span>
                                                    <input type="text" class="form-control" id="FirstName">
                                                </div>
                                            </div>
                                            <div class="col-sm-6">
                                                <div class="visible-xs" style="margin-top:15px;"><label class="control-label" for="LastName">Last Name: <b>*</b></label></div>
                                                <div class="input-group">
                                                    <span class="input-group-addon"><span class="glyphicon glyphicon-user"></span></span>
                                                    <input type="text" class="form-control" id="LastName">
                                                </div>
                                            </div>
                                        </div>
                                    </div>
                                </div>
                                <div class="form-group">
                                    <label class="control-label col-sm-3" for="email">Email: <b>*</b></label>
                                    <div class="col-sm-9">
                                        <div class="input-group">
                                            <span class="input-group-addon">@</span>
                                            <input type="email" class="form-control" id="email">
                                        </div>
                                    </div>
                                </div>
                                <div class="form-group">
                                    <label class="control-label col-sm-3" for="Telephone">Telephone: <b>*</b></label>
                                    <div class="col-sm-9">
                                        <div class="input-group">
                                            <span class="input-group-addon"><span class="glyphicon glyphicon-phone-alt"></span></span>
                                            <input type="tel" class="form-control" id="Telephone">
                                        </div>
                                    </div>
                                </div>
                                <div class="form-group">
                                    <label class="control-label col-sm-3 text-right" for="email">Message:</label>
                                    <div class="col-sm-9">
                                        <textarea class="form-control" rows="4" id="YourMessage"></textarea>
                                    </div>
                                </div>
                                <div class="form-group">
                                    <div class="col-sm-offset-3 col-sm-9">
                                        <button type="submit" class="btn btn-primary">Send <span class="glyphicon glyphicon-send"></span></button>
                                    </div>
                                </div>
                            </form>
                        </div>
                    </div>
                </div>
                <div class="col-sm-5">
                	Antrim Inc<br />
8 Tantum Ct, Bordentown, NJ – 08505<br />
Ph: 609-228-5773<br />
Fax: 609-643-4183<br />
<a href="mailto:info@antrim-inc.com">Info@antrim-inc.com</a><br />
<a href="mailto:sales@antrim-inc.com">sales@antrim-inc.com</a><br />
                </div>
            </div>