fbpx
free
lg
<!-- INSERT THE FOLLOWING IN BETWEEN THE ‘BODY’ TAGS IN YOUR HTML PAGE --> <!-- [et_pb_line_break_holder] --><META HTTP-EQUIV="Content-type" CONTENT="text/html; charset=UTF-8"><!-- [et_pb_line_break_holder] --><script src="https://www.methodintegration.com/MethodWebForms/Javascript/formValidation.js" type="text/javascript"></script><!-- [et_pb_line_break_holder] --><script type="text/javascript"><!-- [et_pb_line_break_holder] -->function validate_form(thisform){<!-- [et_pb_line_break_holder] --> with (thisform){<!-- [et_pb_line_break_holder] --> if (validate_required("FirstName_Step2","vld_FirstName_Step2","First Name must be filled out!")==false)<!-- [et_pb_line_break_holder] -->{document.getElementById("FirstName_Step2").focus();return false;}<!-- [et_pb_line_break_holder] --> if (validate_required("Phone_Step2","vld_Phone_Step2","Phone must be filled out!")==false)<!-- [et_pb_line_break_holder] -->{document.getElementById("Phone_Step2").focus();return false;}<!-- [et_pb_line_break_holder] --> if (validate_required("Email_Step2","vld_Email_Step2","Email must be filled out!")==false)<!-- [et_pb_line_break_holder] -->{document.getElementById("Email_Step2").focus();return false;}<!-- [et_pb_line_break_holder] --> if (validate_maxLength("Description_Step3","vld_Description_Step3","Details: maximum length should be 4000 characters!",4000)==false)<!-- [et_pb_line_break_holder] -->{document.getElementById("Description_Step3").focus();return false;}<!-- [et_pb_line_break_holder] --> document.getElementById('submit_web_form').disabled=true;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] -->}<!-- [et_pb_line_break_holder] --></script><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><form action="https://www.methodintegration.com/method/timezonerouter.aspx?url=https://www.methodintegration.com/MethodWebForms/submit.aspx" onsubmit="return validate_form(this)" method="POST"><!-- [et_pb_line_break_holder] --><input type="hidden" name="oid" value="XG1RCcDVl7uJuho9P1Pq+A=="/><!-- [et_pb_line_break_holder] --><input type="hidden" name="retURL" value="http://"/><!-- [et_pb_line_break_holder] --><input type="hidden" name="formName" value="Web-To-Lead 11-20-2020"/><!-- [et_pb_line_break_holder] --><h3>Contact Information</h3><!-- [et_pb_line_break_holder] --><h4>Please enter your contact information below.</h4><!-- [et_pb_line_break_holder] --><table><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td valign ="top"><!-- [et_pb_line_break_holder] --> <label for="FirstName_Step2">First Name</label><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td><!-- [et_pb_line_break_holder] --> <input type="text" id="FirstName_Step2" name="FirstName_Step2" maxlength="25" size="20" value="" /><!-- [et_pb_line_break_holder] --> <span id="vld_FirstName_Step2" style="color:Red">*</span><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td valign ="top"><!-- [et_pb_line_break_holder] --> <label for="LastName_Step2">Last Name</label><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td><!-- [et_pb_line_break_holder] --> <input type="text" id="LastName_Step2" name="LastName_Step2" maxlength="100" size="20" value="" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td valign ="top"><!-- [et_pb_line_break_holder] --> <label for="Phone_Step2">Phone</label><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td><!-- [et_pb_line_break_holder] --> <input type="text" id="Phone_Step2" name="Phone_Step2" maxlength="30" size="20" value="" /><!-- [et_pb_line_break_holder] --> <span id="vld_Phone_Step2" style="color:Red">*</span><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td valign ="top"><!-- [et_pb_line_break_holder] --> <label for="Email_Step2">Email</label><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td><!-- [et_pb_line_break_holder] --> <input type="text" id="Email_Step2" name="Email_Step2" maxlength="100" size="20" value="" /><!-- [et_pb_line_break_holder] --> <span id="vld_Email_Step2" style="color:Red">*</span><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td valign ="top"><!-- [et_pb_line_break_holder] --> <label for="BillAddressAddr1_Step2">Address</label><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td><!-- [et_pb_line_break_holder] --> <input type="text" id="BillAddressAddr1_Step2" name="BillAddressAddr1_Step2" maxlength="500" size="20" value="" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td valign ="top"><!-- [et_pb_line_break_holder] --> <label for="BillAddressCity_Step2">City</label><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td><!-- [et_pb_line_break_holder] --> <input type="text" id="BillAddressCity_Step2" name="BillAddressCity_Step2" maxlength="255" size="20" value="" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td valign ="top"><!-- [et_pb_line_break_holder] --> <label for="BillAddressState_Step2">State</label><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td><!-- [et_pb_line_break_holder] --> <input type="text" id="BillAddressState_Step2" name="BillAddressState_Step2" maxlength="255" size="20" value="" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td valign ="top"><!-- [et_pb_line_break_holder] --> <label for="BillAddressPostalCode_Step2">Postal Code</label><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td><!-- [et_pb_line_break_holder] --> <input type="text" id="BillAddressPostalCode_Step2" name="BillAddressPostalCode_Step2" maxlength="30" size="20" value="" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --></table><!-- [et_pb_line_break_holder] --><h3>Products & Services</h3><!-- [et_pb_line_break_holder] --><h4>Please let us know what product(s) or service(s) are you interested in.</h4><!-- [et_pb_line_break_holder] --><table><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td valign ="top"><!-- [et_pb_line_break_holder] --> <label for="LeadInterestMosquito_Step3">Lead Interest Mosquito</label><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td><!-- [et_pb_line_break_holder] --> <input type="checkbox" id="LeadInterestMosquito_Step3" name="LeadInterestMosquito_Step3" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td valign ="top"><!-- [et_pb_line_break_holder] --> <label for="LeadInterestCooling_Step3">Lead Interest Cooling</label><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td><!-- [et_pb_line_break_holder] --> <input type="checkbox" id="LeadInterestCooling_Step3" name="LeadInterestCooling_Step3" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td valign ="top"><!-- [et_pb_line_break_holder] --> <label for="Description_Step3">Details:</label><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td><!-- [et_pb_line_break_holder] --> <textarea rows="5" id="Description_Step3" name="Description_Step3" ></textarea><!-- [et_pb_line_break_holder] --> <span id="vld_Description_Step3" style="color:Red"></span><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --></table><!-- [et_pb_line_break_holder] --><input type="submit" name="submit_web_form" id="submit_web_form" value="Submit" /><!-- [et_pb_line_break_holder] --></form><!-- [et_pb_line_break_holder] -->
mm