<div class="gform_wrapper">
  <form action="">

    <div class="gform_body">
      <ul class="gform_fields top_label form_sublabel_below description_below">
        <li class="gfield gf_left_half">
          <div class="ginput_container">
            <label class="gfield_label">First Name <span class="gfield_required">*</span></label>
            <input type="text" class="medium">
          </div>
        </li>
        <li class="gfield gf_right_half">
          <div class="ginput_container">
            <label class="gfield_label">Last Name <span class="gfield_required">*</span></label>
            <input type="text" class="medium">
          </div>
        </li>
        <li class="gfield field_sublabel_below">
          <div class="ginput_container">
            <label class="gfield_label">Address</label>
            <input type="text" class="medium">
            <label>Street Address</label>
          </div>
        </li>
        <li class="gfield">
          <div class="ginput_container">
            <label class="gfield_label">How did you hear about us?</label>
            <select>
              <option value="" selected="selected">The World Wide Web, my dude</option>
              <option value="Afghanistan">Afghanistan</option>
              <option value="Albania">Albania</option>
              <option value="Algeria">Algeria</option>
            </select>
          </div>
        </li>
        <li class="gfield">
          <div class="ginput_container">
            <label class="gfield_label">Address</label>
            <textarea></textarea>
          </div>
        </li>
      </ul>
    </div>

    <div class="gform_footer top_label">
      <input type="submit" class="gform_button button" value="Submit">
    </div>

  </form>
</div>