<div class='block-terc' style='height:350px'>

{{form->Open()}}
{{form->Error()}}
{{form->Success()}}

    <h2>{{GetCode(ImmoLeadPlugin.AskToBeCalledBack)}}</h2>
    
    <div class='col-md-12'>
        <label>{{GetCode(ImmoLeadPlugin.Phone)}}</label> 
        {{form->Render(Phone)}}
    </div>

    <div class='col-md-6'>
        <label>{{GetCode(ImmoLeadPlugin.DateCall)}}</label> 
        {{form->Render(DateCall)}}
    </div>

    <div class='col-md-6'>
        <label>{{GetCode(ImmoLeadPlugin.HourCall)}}</label> 
        {{form->Render(HourCall)}}
    </div>
    

    <div class='col-md-12 center marginTop' >   
        {{form->Render(btnSendCalledBackForm)}}
    </div>
    
{{form->Close()}}


</div>