Name*
[text* name id:name placeholder "Your Name" required]

Phone Number*
[tel* phone id:phone placeholder "+91XXXXXXXXXX" required]

Email Address*
[email* email id:email placeholder "you@example.com" required]

Address*
[textarea* address id:address placeholder "Your Address" required]

Type*
[select* type id:type include_blank "Select Type" "Business" "Retail" required]