<style type="text/css">
.contact ul {width:600px; margin:0; padding:0; list-style:none;}
.contact li {margin-bottom:10px; overflow:hidden;}
.contact label {display:block; margin-bottom:2px;}
.contact .input {width:100%; border:1px solid #E0E0E0; background:#F6F6F6;}
.contact .half {float:left; width:50%;}
.contact .third {float:left; width:33.33%;}
.contact .half div, .contact .third div {margin-right:10px;}
.contact .omega div {margin-right:0;}
</style>
<form action="/contact-us" method="post" class="contact">
<ul>
<li>
<div class="half">
<div>
<label for="name">Name:</label>
<input type="text" id="name" name="name" class="input" />
</div>
</div>
<div class="half omega">
<div>
<label for="email">Email:</label>
<input type="text" id="email" name="email" class="input" />
</div>
</div>
</li>
<li>
<label for="address">Address:</label>
<input type="text" id="address" name="address" class="input" />
</li>
<li>
<div class="third">
<div>
<label for="city">City:</label>
<input type="text" id="city" name="city" class="input" />
</div>
</div>
<div class="third">
<div>
<label for="state">State:</label>
<input type="text" id="state" name="state" class="input" />
</div>
</div>
<div class="third omega">
<div>
<label for="zip">Zip:</label>
<input type="text" id="zip" name="zip" class="input" />
</div>
</div>
</li>
</ul>
</form>