<div class="form-contact">
				<div class="form-group">
		  <p> <label class="control-label gcore-label-left gcore-label-checkbox">FAHRZEUG </label></p>
		   <div class="gcore-display-table">
			  <div class="gcore-single-column">
                                      [radio radio-group class:gcore-radio-item label_first use_label_element "TAXI&nbsp;&nbsp;" "BUS&nbsp;&nbsp;&nbsp;" "LIMOUSINE&nbsp;&nbsp;&nbsp;" "KRANKENTRANSPORTER&nbsp;&nbsp;&nbsp;"]
			  </div>
		</div>
		<div class="form-group">
		  <p> <label class="control-label gcore-label-left required_label">UHRZEIT </label></p>
		   <div class="gcore-display-table" >
			    [text* hours 60/ class:form-control]
		   </div>
		</div>
		<div class="form-group">
			<p><label class="control-label gcore-label-left">ABFAHRT </label></p>
			<div class="gcore-display-table">
                               [text* start_destination 60/ class:form-control]
			</div>
		</div>
		<div class="form-group">
			<p><label class="control-label gcore-label-left">ZIEL </label></p>
			<div class="gcore-display-table">
				 [text* end_destination 60/ class:form-control]
			</div>
		</div>
<div class="form-group">
			<p><label class="control-label gcore-label-left">DATUM </label></p>
		     <div class="gcore-display-table">
                      <span class="wpcf7-form-control-wrap date_time"><input type="date" aria-invalid="false" aria-required="true" id="date-time" class="wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date form-control" value="" name="date_time" size="60"></span>
                       </div>
		   </div>
		</div>
		<div class="form-group">
			<p><label class="control-label gcore-label-left">TELFONNUMMER </label></p>
			<div class="gcore-display-table">
				[tel phone_number 60/11 class:phone-number]
			</div>
		</div>
		<div class="form-group">
			<div class="gcore-display-table">
                                [submit class:btn "jetzt anfragen"]
			</div>
		</div>
	</div>