<br>[text* your-name placeholder "Full Name"]<br>
[text* your-address placeholder "Home Address"]<br>
[tel phone-number placeholder "Phone Number"]<br>
[email* your-email placeholder "Email Address"]<br>
[select* type-of-house "Type Of House" "Bungalow" "One Storey" "Two Storey" "Commercial" "Industry"]<br>
[select* condition-of-roof "Condition of Roof" "Rust" "Moss" "Black Stains" "Others (Please specify below)"]<br>
[text others placeholder "Other condition of roof"]<br>
Kindly upload a picture of the property you want us to work on<br>
[file roof-image limit:7999 filetypes:pdf|doc|jpg|gif|png]<br>
[submit "Send Request"]