Customer Details

<!-- Note :<!-- [et_pb_line_break_holder] --> - You can modify the font style and form style to suit your website. <!-- [et_pb_line_break_holder] --> - Code lines with comments ���Do not remove this code��� are required for the form to work properly, make sure that you do not remove these lines of code. <!-- [et_pb_line_break_holder] --> - The Mandatory check script can modified as to suit your business needs. <!-- [et_pb_line_break_holder] --> - It is important that you test the modified form before going live.--><!-- [et_pb_line_break_holder] --><div id='crmWebToEntityForm' style='width:600px;margin:auto;'><!-- [et_pb_line_break_holder] --> <META HTTP-EQUIV ='content-type' CONTENT='text/html;charset=UTF-8'><!-- [et_pb_line_break_holder] --> <form action='https://crm.zoho.com/crm/WebToLeadForm' name=WebToLeads3094703000000144942 method='POST' onSubmit='javascript:document.charset="UTF-8"; return checkMandatory()' accept-charset='UTF-8'><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <!-- Do not remove this code. --><!-- [et_pb_line_break_holder] --> <input type='text' style='display:none;' name='xnQsjsdp' value='2421f0da92c10c878ecd733a4899bb3eaf96a6c2f9dc40cc4d2eff148b270ada'/><!-- [et_pb_line_break_holder] --> <input type='hidden' name='zc_gad' id='zc_gad' value=''/><!-- [et_pb_line_break_holder] --> <input type='text' style='display:none;' name='xmIwtLD' value='619bc31be4b90a743720a449a1ed6111cc633a99722baee9cb426aa1c8cd60a3'/><!-- [et_pb_line_break_holder] --> <input type='text' style='display:none;' name='actionType' value='TGVhZHM='/><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <input type='text' style='display:none;' name='returnURL' value='https://flooringsourcetx.com/thank-you/' /> <!-- [et_pb_line_break_holder] --> <!-- Do not remove this code. --><!-- [et_pb_line_break_holder] --> <style><!-- [et_pb_line_break_holder] --> tr , td { <!-- [et_pb_line_break_holder] --> padding:6px;<!-- [et_pb_line_break_holder] --> border-spacing:0px;<!-- [et_pb_line_break_holder] --> border-width:0px;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> </style><!-- [et_pb_line_break_holder] --> <table style='width:600px;background-color:white;color:black'><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <tr><td colspan='2' style='text-align:left;color:black;font-family:Arial;font-size:14px;'><strong>Walkin</strong></td></tr><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <tr><td style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>First Name</td><td style='width:250px;' ><input type='text' style='width:250px;' maxlength='40' name='First Name' /></td></tr><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <tr><td style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>Last Name<span style='color:red;'>*</span></td><td style='width:250px;' ><input type='text' style='width:250px;' maxlength='80' name='Last Name' /></td></tr><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <tr><td style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>Email</td><td style='width:250px;' ><input type='text' style='width:250px;' maxlength='100' name='Email' /></td></tr><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <tr><td style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>Phone</td><td style='width:250px;' ><input type='text' style='width:250px;' maxlength='30' name='Phone' /></td></tr><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <tr><td style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>Mobile</td><td style='width:250px;' ><input type='text' style='width:250px;' maxlength='30' name='Mobile' /></td></tr><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <tr><td style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>Street</td><td style='width:250px;' ><input type='text' style='width:250px;' maxlength='250' name='Street' /></td></tr><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <tr><td style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>City</td><td style='width:250px;' ><input type='text' style='width:250px;' maxlength='30' name='City' /></td></tr><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <tr><td style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>State</td><td style='width:250px;' ><input type='text' style='width:250px;' maxlength='30' name='State' /></td></tr><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <tr><td style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>Zip Code</td><td style='width:250px;' ><input type='text' style='width:250px;' maxlength='30' name='Zip Code' /></td></tr><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <tr style='display:none;' ><td style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:50%'>Lead Source</td><td style='width:250px;'><!-- [et_pb_line_break_holder] --> <select style='width:250px;' name='Lead Source'><!-- [et_pb_line_break_holder] --> <option value='-None-'>-None-</option><!-- [et_pb_line_break_holder] --> <option value='Advertisement'>Advertisement</option><!-- [et_pb_line_break_holder] --> <option value='Cold Call'>Cold Call</option><!-- [et_pb_line_break_holder] --> <option value='Employee Referral'>Employee Referral</option><!-- [et_pb_line_break_holder] --> <option value='External Referral'>External Referral</option><!-- [et_pb_line_break_holder] --> <option value='Internet'>Internet</option><!-- [et_pb_line_break_holder] --> <option value='Partner'>Partner</option><!-- [et_pb_line_break_holder] --> <option value='Public Relations'>Public Relations</option><!-- [et_pb_line_break_holder] --> <option value='Sales Email Alias'>Sales Email Alias</option><!-- [et_pb_line_break_holder] --> <option value='Internal Seminar'>Internal Seminar</option><!-- [et_pb_line_break_holder] --> <option value='Trade Show'>Trade Show</option><!-- [et_pb_line_break_holder] --> <option value='Web Download'>Web Download</option><!-- [et_pb_line_break_holder] --> <option value='Web Research'>Web Research</option><!-- [et_pb_line_break_holder] --> <option value='Chat'>Chat</option><!-- [et_pb_line_break_holder] --> <option value='Existing Client'>Existing Client</option><!-- [et_pb_line_break_holder] --> <option selected value='Walkin'>Walkin</option><!-- [et_pb_line_break_holder] --> </select></td></tr><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <tr><td colspan='2' style='text-align:center; padding-top:15px;'><!-- [et_pb_line_break_holder] --> <input style='font-size:12px;color:#131307' type='submit' value='Submit' /><!-- [et_pb_line_break_holder] --> <input type='reset' style='font-size:12px;color:#131307' value='Reset' /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> </table><!-- [et_pb_line_break_holder] --> <script><!-- [et_pb_line_break_holder] --> var mndFileds=new Array('Last Name');<!-- [et_pb_line_break_holder] --> var fldLangVal=new Array('Last Name');<!-- [et_pb_line_break_holder] --> var name='';<!-- [et_pb_line_break_holder] --> var email='';<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> function checkMandatory() {<!-- [et_pb_line_break_holder] --> for(i=0;i<mndFileds.length;i++) {<!-- [et_pb_line_break_holder] --> var fieldObj=document.forms['WebToLeads3094703000000144942'][mndFileds[i]];<!-- [et_pb_line_break_holder] --> if(fieldObj) {<!-- [et_pb_line_break_holder] --> if (((fieldObj.value).replace(/^\s+|\s+$/g, '')).length==0) {<!-- [et_pb_line_break_holder] --> if(fieldObj.type =='file')<!-- [et_pb_line_break_holder] --> { <!-- [et_pb_line_break_holder] --> alert('Please select a file to upload.'); <!-- [et_pb_line_break_holder] --> fieldObj.focus(); <!-- [et_pb_line_break_holder] --> return false;<!-- [et_pb_line_break_holder] --> } <!-- [et_pb_line_break_holder] --> alert(fldLangVal[i] +' cannot be empty.'); <!-- [et_pb_line_break_holder] --> fieldObj.focus();<!-- [et_pb_line_break_holder] --> return false;<!-- [et_pb_line_break_holder] --> } else if(fieldObj.nodeName=='SELECT') {<!-- [et_pb_line_break_holder] --> if(fieldObj.options[fieldObj.selectedIndex].value=='-None-') {<!-- [et_pb_line_break_holder] --> alert(fldLangVal[i] +' cannot be none.'); <!-- [et_pb_line_break_holder] --> fieldObj.focus();<!-- [et_pb_line_break_holder] --> return false;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> } else if(fieldObj.type =='checkbox'){<!-- [et_pb_line_break_holder] --> if(fieldObj.checked == false){<!-- [et_pb_line_break_holder] --> alert('Please accept '+fldLangVal[i]);<!-- [et_pb_line_break_holder] --> fieldObj.focus();<!-- [et_pb_line_break_holder] --> return false;<!-- [et_pb_line_break_holder] --> } <!-- [et_pb_line_break_holder] --> } <!-- [et_pb_line_break_holder] --> try {<!-- [et_pb_line_break_holder] --> if(fieldObj.name == 'Last Name') {<!-- [et_pb_line_break_holder] --> name = fieldObj.value;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> } catch (e) {}<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --></script><!-- [et_pb_line_break_holder] --> </form><!-- [et_pb_line_break_holder] --></div>