"Service Request Form"
Bootstrap 3.3.0 Snippet by luckyus626

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<link href="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css">
<script src="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/js/bootstrap.min.js"></script>
<script src="//code.jquery.com/jquery-1.11.1.min.js"></script>
<!------ Include the above in your HEAD tag ---------->
<form class="form-horizontal">
<fieldset>
<!-- Form Name -->
<legend>Service Request Form</legend>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label" for="name">Contact Name</label>
<div class="col-md-4">
<input id="name" name="name" placeholder="name" class="form-control input-md" required="" type="text">
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label" for="contact#">Contact Phone</label>
<div class="col-md-4">
<input id="contact#" name="contact#" placeholder="(xxx) xxx-xxxx" class="form-control input-md" required="" type="text">
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label" for="e-mail">E-mail</label>
<div class="col-md-4">
<input id="e-mail" name="e-mail" placeholder="ex: you@emailaddress.com" class="form-control input-md" required="" type="text">
</div>
</div>
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