[gvs_form inputs='[{“title”:”First Name”,”input_type”:”text”,”placeholder”:” “,”input_values”:”[{}]”,”width”:”col-md-12″,”endpoint_field_name”:”first_name”},{“title”:”Last Name”,”input_type”:”text”,”placeholder”:” “,”input_values”:”[{}]”,”width”:”col-md-12″,”endpoint_field_name”:”last_name”},{“title”:”Email”,”input_type”:”email”,”placeholder”:” “,”input_values”:”[{}]”,”required”:”yes”,”width”:”col-md-12″,”endpoint_field_name”:”email”},{“title”:”Phone”,”input_type”:”text”,”placeholder”:” “,”input_values”:”[{}]”,”width”:”col-md-12″,”endpoint_field_name”:”phone”},{“title”:”Benefit #”,”input_type”:”text”,”placeholder”:” “,”input_values”:”[{}]”,”width”:”col-md-12″,”endpoint_field_name”:”benefit_number”},{“title”:”Comments”,”input_type”:”textfield”,”placeholder”:” “,”input_values”:”[{}]”,”width”:”col-md-12″,”endpoint_field_name”:”comment”}]’ endpoint=”GVS_Contact_Us_app”]