index.css

button {
  margin-left: 5px;
}

input {
  margin: 5px;
}

form {
  padding-right: 10px;
}

index.html

<script src="https://fb.me/react-with-addons-0.14.0.js"></script>
<script src="https://fb.me/react-dom-0.14.0.js"></script>

<div id="view" />

index.js

// Convert the html template with https://magic.reactjs.net/htmltojsx.htm

var TextBox = React.createClass({
    render: function () {
        return (
            <input className='form-control'
                name={this.props.name}
                type='text'
                value={this.props.value}
                onChange={this.props.onChange} />
        );
    }
});

var ExampleForm = React.createClass({
    getInitialState: function () {
        return {
            form: {
                name: 'John Doe',
                title: 'Engineer',
                email: 'john.doe@innablr.com.au',
                phone: '+61 435 123 456'
            }
        }
    },
    onChange: function (event) {
        this.state.form[event.target.name] = event.target.value;

        this.setState({ form: this.state.form });
    },
    onSubmit: function (event) {
        event.preventDefault();
    },
    render: function () {
        var self = this;
        return (
            <form onSubmit={this.onSubmit}>
                <TextBox name='name' value={this.state.form.name} onChange={this.onChange} />

                <TextBox name='title' value={this.state.form.title} onChange={this.onChange} />

                <TextBox name='email' value={this.state.form.email} onChange={this.onChange} />

                <TextBox name='phone' value={this.state.form.phone} onChange={this.onChange} />
                
                <hr/>

                <table cellSpacing={0} cellPadding={0} border={0}>
                    <tbody>
                        <tr>
                            <td style={{ borderRight: '2px solid #231f20', padding: '0 10px 0 5px', verticalAlign: 'middle' }} valign="middle">
                                <a href="https://innablr.com.au" target="_blank"><img width={72} height={86} src="https://www.innablr.com.au/signature-logos/innablr.gif" alt="Innablr" style={{ maxHeight: '86px', width: 'auto !important', display: 'block', border: 'none' }} /></a>
                            </td>
                            <td style={{ verticalAlign: 'middle', paddingLeft: '10px' }}>
                                <table cellSpacing={0} cellPadding={0} border={0}>
                                    <tbody>
                                        <tr>
                                            <td style={{ paddingBottom: '0px', fontFamily: 'Verdana', fontSize: '9pt', color: '#231f20' }}>
                                                <font style={{ fontWeight: 'bold', fontFamily: 'Verdana', fontSize: '9pt', color: '#231f20' }}>{this.state.form.name}</font>
                                            </td>
                                        </tr>
                                        <tr>
                                            <td style={{ paddingBottom: '5px', fontFamily: 'Verdana', fontSize: '9pt', color: '#231f20' }}>
                                                <font style={{ fontFamily: 'Verdana', fontSize: '9pt', color: '#231f20' }}>{this.state.form.title}</font>
                                            </td>
                                        </tr>
                                        <tr>
                                            <td style={{ paddingBottom: '0px', fontFamily: 'Verdana', fontSize: '9pt' }}>
                                                <font style={{ color: '#333333', fontSize: '9pt', fontFamily: 'Verdana' }}><b>m.</b> <a href={'tel:' + this.state.form.phone.replace(/ /g,'')} style={{ color: '#6244bb', textDecoration: 'none' }} target="_blank">{this.state.form.phone}</a></font>
                                            </td>
                                        </tr>
                                        <tr>
                                            <td style={{ paddingBottom: '0px', fontFamily: 'Verdana', fontSize: '9pt' }}>
                                                <font style={{ color: '#333333', fontSize: '9pt', fontFamily: 'Verdana' }}><b>e.</b> <a href={'mailto:' + this.state.form.email} style={{ color: '#6244bb', textDecoration: 'none' }} target="_blank">{this.state.form.email}</a></font>
                                            </td>
                                        </tr>
                                        <tr>
                                            <td style={{ paddingBottom: '5px', fontFamily: 'Verdana', fontSize: '9pt' }}>
                                                <font style={{ color: '#333333', fontSize: '9pt', fontFamily: 'Verdana' }}><b>w.</b> <a href="https://innablr.com.au" style={{ color: '#6244bb', textDecoration: 'none' }} target="_blank">innablr.com.au</a></font>
                                            </td>
                                        </tr>
                                        <tr>
                                            <td style={{ paddingBottom: '0px', fontFamily: 'Verdana', fontSize: '9pt' }}>
                                                <table cellSpacing={0} cellPadding={0} border={0}>
                                                    <tbody>
                                                        <tr>
                                                            <td style={{ padding: '0 2px 0 0' }}>
                                                                <a href="https://www.linkedin.com/company/innablr" style={{ color: '#6244bb', textDecoration: 'none' }} target="_blank"><img src="https://www.innablr.com.au/signature-logos/linkedin.png" alt="LinkedIn" width={12} height={12} style={{ maxHeight: '12px', width: 'auto !important', display: 'block', border: 'none' }} /></a>
                                                            </td>
                                                            <td style={{ padding: '1px 2px 0 2px' }}>
                                                                <a href="https://twitter.com/InnablrTech" style={{ color: '#6244bb', textDecoration: 'none' }} target="_blank"><img src="https://www.innablr.com.au/signature-logos/twitter.png" alt="Twitter" width={13} height={11} style={{ maxHeight: '11px', width: 'auto !important', display: 'block', border: 'none' }} /></a>
                                                            </td>
                                                            <td style={{ padding: '0 2px' }}>
                                                                <a href="https://www.facebook.com/InnablrTech" style={{ color: '#6244bb', textDecoration: 'none' }} target="_blank"><img src="https://www.innablr.com.au/signature-logos/facebook.png" alt="Facebook" width={6} height={12} style={{ maxHeight: '12px', width: 'auto !important', display: 'block', border: 'none' }} /></a>
                                                            </td>
                                                            <td style={{ padding: '0 2px' }}>
                                                                <a href="https://goo.gl/maps/GtZMJSCMsuu" style={{ color: '#6244bb', textDecoration: 'none' }} target="_blank"><img src="https://www.innablr.com.au/signature-logos/pin.png" alt="Map" width={7} height={12} style={{ maxHeight: '12px', width: 'auto !important', display: 'block', border: 'none' }} /></a>
                                                            </td>
                                                        </tr>
                                                    </tbody>
                                                </table>
                                            </td>
                                        </tr>
                                    </tbody>
                                </table>
                            </td>
                        </tr>
                    </tbody>
                </table>
            </form>
        );
    }
});

ReactDOM.render(
    <ExampleForm />,
    document.getElementById('view'));

http://jsfiddle.net/jamesmoriarty/0mw2o71k/