<div class="g5plus-mailchimp">
  <div class="mailchimp-title">
     <h4 class="primary-font fs-33 accent-color">Get A Quote</h4>
     <span class="fs-14 heading-color">To Start Your Project</span>
   </div>
	<p>
      <input type="text" name="name" placeholder="Your Name" required />
  </p>
  <p>
    <input type="email" name="EMAIL" placeholder="Email Address" required />
  </p>
  <p>
    <input type="text" name="name" placeholder="Phone Number" required />
  </p>
  <input type="submit" name="submit" value="Contact Now" class="submit btn btn-block btn-primary heading_font fs-12"/>    
</div>