<div class="step_form_wrap">
<div class="row">
<div class="col-lg-12 form_heading"><strong>1</strong><h6>Please select the model below</h6></div>
<div class="col-lg-6"><div class="input-row">[number* number-366 placeholder "Serial number*"]</div></div>
<div class="col-lg-6"><div class="input-row">[text* text-367 placeholder "Product*"]</div></div>
<div class="col-lg-12 form_heading"><strong>2</strong><h6>Please describe the concern you are seeking help with</h6></div>
<div class="col-lg-12 step_two"><div class="input-row">[text* text-368 placeholder "Enter request details"]</div></div>
<div class="col-lg-12 form_heading"><strong>3</strong><h6>Contact information</h6></div>
<div class="col-lg-6"><div class="input-row">[text* text-369 placeholder "First name*"]</div></div>
<div class="col-lg-6"><div class="input-row">[text* text-370 placeholder "Last name*"]</div></div>
<div class="col-lg-6"><div class="input-row">[text* text-371 placeholder "E-mail*"]</div></div>
<div class="col-lg-12"><div class="input-row"></div></div>
<div class="col-lg-6"><div class="input-row">[text* text-372 placeholder "Mobile / Telephone number*"]</div></div>
<div class="col-lg-12"><div class="input-row">[text* text-373 placeholder "Company name*"]</div></div>
<div class="col-lg-6"><div class="input-row">[text* text-374 placeholder "Street Address*"]</div></div>
<div class="col-lg-6"><div class="input-row">[text* text-375 placeholder "Zip / Postal Code*"]</div></div>
<div class="col-lg-6"><div class="input-row">[text* text-376 placeholder "City / State or providence*"]<p class="refrence_ind">* Mandatory fields</p></div></div>
<div class="col-lg-6"><div class="input-row">[select* menu-505 class:countery_dropdowen first_as_label "Country" "USA" "Canada"]<p class="refrence_ind country_req">* Pflichtfelder</p></div></div>
<div class="col-lg-6"><div class="input-row">[textarea textarea-377 placeholder "Comments"]</div></div>
<div class="col-lg-12 form_heading"><strong>4</strong><h6>Attachments/Upload</h6></div>
<div class="col-lg-6"><div class="input-row fileuplod-input-row">[mfile upload-file-992 limit:5242880 class:file_upload_new "Durchsuchen"]<p>Upload up to 3 files.<br>Maximum file size: 5 MB</p></div></div>
<div class="col-lg-12"><div class="btnbox flxrow"><button class="primary-btn" type="submit">Submit<i></i></button></div></div></div></div>