<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>