<p>Name: (required)<br />
    [text* your-name] </p>

<p>Telephone: (required)<br />
    [tel* your-telephone] </p>

<p>Email:<br />
    [email your-email] </p>

<p>When are you available? (required)<br />
   [date* preferred-date] </p>

<p>What does this regard?<br />
    [text your-subject] </p>

<p>Your Message:<br />
    [textarea your-message] </p>

<p>[submit "Submit"]</p>