<div class="row">
		<div class="grid-1-1">
			[text* Societatea Comerciala placeholder "Societatea Comerciala:"]
		</div>
<div class="grid-1-1">
			[text* Cu sediul in placeholder "Cu sediul in:"]
		</div>
<div class="grid-1-4">
			[text* CUI placeholder "CUI"]
		</div>
<div class="grid-1-4">
			[text* J placeholder "J"]
		</div>

		<div class="grid-1-4">
			[text* E-mail placeholder "EMAIL"]
		</div>
		<div class="grid-1-4">
			[text Telefon placeholder "Telefon"]
		</div>
	<div class="grid-1-1">
		[text* Reprezentanti placeholder "Confirmam prezenta reprezentantilor:"]
	</div>
	
	<div style= "text-align: right;">[submit "TRIMITE →"]</div>
</div>