<!DOCTYPE html>
<html lang=”en”>
<head>
<meta charset=”UTF-8″>
<title>Contact Form</title>
<style>
body {
font-family: Arial, sans-serif;
background-color: #d9f5d3;
margin: 0;
padding: 20px;
}
.form-container {
background: white;
max-width: 600px;
margin: 0 auto;
padding: 30px;
border-radius: 10px;
box-shadow: 0 0 10px rgba(0,0,0,0.1);
}
h2 {
font-family: Arial, sans-serif;
margin-bottom: 5px;
}
p {
margin-top: 0;
font-weight: bold;
font-family: Arial, sans-serif;
}
label {
display: block;
margin-top: 15px;
font-weight: bold;
}
input[type=”text”],
select {
width: 100%;
padding: 10px;
margin-top: 5px;
border: 1px solid #ccc;
border-radius: 5px;
box-sizing: border-box;
font-size: 14px;
}
input[readonly] {
background-color: #f0f0f0;
cursor: not-allowed;
}
input[type=”submit”] {
background-color: #4CAF50;
color: white;
padding: 12px 20px;
margin-top: 20px;
border: none;
border-radius: 5px;
cursor: pointer;
font-size: 16px;
}
input[type=”submit”]:hover {
background-color: #45a049;
}
</style>
</head>
<body>
<div class=”form-container”>
<h2><center>Contact Information</center></h2>
<p><center><b>Anderson Power Services </b> </center></p>
<form action=”https://webto.salesforce.com/servlet/servlet.WebToLead?encoding=UTF-8&orgId=00DHr0000074qVH” method=”POST”>
<input type=”hidden” name=”oid” value=”00DHr0000074qVH”>
<input type=”hidden” name=”retURL” value=”https://andersonpowerservices.com/?page_id=140492&preview=true“>
<label for=”first_name”>First Name</label>
<input id=”first_name” maxlength=”40″ name=”first_name” type=”text” required />
<label for=”last_name”>Last Name</label>
<input id=”last_name” maxlength=”80″ name=”last_name” type=”text” required />
<label for=”mobile”>Mobile</label>
<input id=”mobile” maxlength=”40″ name=”mobile” type=”text” required />
<label for=”email”>Email</label>
<input id=”email” maxlength=”80″ name=”email” type=”text” required />
<label for=”zip”>Zip</label>
<input id=”zip” maxlength=”20″ name=”zip” type=”text” required />
<label for=”state_code”>State/Province</label>
<input id=”state_code” name=”state_code” value=”SC” type=”text” readonly required />
<label for=”00NHr00000xU5Vf”>Branch</label>
<select id=”00NHr00000xU5Vf” name=”00NHr00000xU5Vf” required>
<option value=”Greenville”>Greenville</option>
</select>
<label for=”lead_source”>Lead Source</label>
<select id=”lead_source” name=”lead_source” required>
<option value=”S.C Southern Home & Garden Expo”>S.C Southern Home & Garden Expo</option>
</select>
<input type=”submit” name=”submit” value=”Submit”>
</form>
</div>
</body>
</html>
