Simple 2 Column Quick Contact form

Hello - please can you help!!

I would like a form that firstly, has the titles hidden. I'm using this code for that:

.form-wrapper .field-list .field {
 margin: 0px 0px 11px 0%;
}

     .form-wrapper .field-list .field .option {
       /* Show radio buttons side-by-side */
       display: inline;
       margin-right: 5px;
   }

.sqs-block-form .field-list .title
  {
    display: none;
  }

which works perfectly.

What I'd then like is:

Left Column:
Text Field (for name, but I dont want the First Name, Last name, so just a text box is fine)
Text Field (for phone number, but the SS phone number doesn't validate UK numbers)
Email

Right Column:
Text Area
Captcha
Submit button

Help is greatfully received!!! Thanks in advance, I've been pulling my spanners out about this!!!!

Hi,

Can you share link to page where you use form?

Thanks Tuanphan - I have emailed you directly through your website, as I didn't want to post passwords here. I hope that's ok.