			<div class="input-wrap m-full-width">
				<i class="icon-user"></i>
				<input class="field-name" type="text" placeholder="Ваше имя (*)" name="name" data-content="" value="" required style="background:#fff;">
			</div>
			<div class="input-wrap m-full-width">
				<i class="icon-phone"></i>
				<input class="field-phone" type="tel" placeholder="Телефон (*)" name="phone" data-content="" value="" required style="background:#fff;">
			</div>