<link href="//netdna.bootstrapcdn.com/bootstrap/3.0.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css"> <script src="//netdna.bootstrapcdn.com/bootstrap/3.0.0/js/bootstrap.min.js"></script> <script src="//code.jquery.com/jquery-1.11.1.min.js"></script> <!------ Include the above in your HEAD tag ----------> <div class="row"> <div class="col-md-4 col-md-offset-4"> <form class="form-horizontal" role="form"> <script type="text/javascript" src="http://crm.virtuedesk.com/crm/cache/include/javascript/calendar.js?v=-VbrIv82NwOpJ3Zh9enBog"></script> <form id="WebToLeadForm" action="http://crm.virtuedesk.com/crm/index.php?entryPoint=WebToLeadCapture" method="POST" name="WebToLeadForm"> <table style="border-top-width: 1px; border-top-style: solid; border-bottom-width: 1px; border-bottom-style: solid; padding: 10px 6px 12px 10px; background-color: #e9f3ff; font-size: 12px; width: 100%; background-position: 50% 0%; background-repeat: repeat no-repeat;"> <tbody> <tr style="color: #0069e1; font-family: Arial,Verdana,Helvetica,sans-serif; font-size: 18px; font-weight: bold; margin-bottom: 0px; margin-top: 0px;" align="center"> <td colspan="4"> <h2>Demo Request Form</h2> </td> </tr> <tr style="color: #0069e1; font-family: Arial,Verdana,Helvetica,sans-serif; font-size: 2px; font-weight: normal; margin-bottom: 0px; margin-top: 0px;" align="center"> <td colspan="4">� </td> </tr> <tr style="color: #0069e1; font-family: Arial,Verdana,Helvetica,sans-serif; font-size: 12px; font-weight: normal; margin-bottom: 0px; margin-top: 0px;" align="left"> <td colspan="4">Request information for a demo</td> </tr> <tr style="color: #0069e1; font-family: Arial,Verdana,Helvetica,sans-serif; font-size: 8px; font-weight: normal; margin-bottom: 0px; margin-top: 0px;" align="center"> <td colspan="4">� </td> </tr> <tr> <td style="text-align: left; font-size: 12px; font-weight: normal;" width="15%"><span>First Name: </span></td> <td style="font-size: 12px; font-weight: normal;" width="35%"><span><input id="first_name" type="text" name="first_name" /></span></td> <td style="text-align: left; font-size: 12px; font-weight: normal;" width="15%"><span>Last Name: <span class="required" style="color: #ff0000;">*</span></span></td> <td style="font-size: 12px; font-weight: normal;" width="35%"><span><input id="last_name" type="text" name="last_name" /></span></td> </tr> <tr> <td style="text-align: left; font-size: 12px; font-weight: normal;" width="15%"><span>Title: </span></td> <td style="font-size: 12px; font-weight: normal;" width="35%"><span><input id="title" type="text" name="title" /></span></td> <td style="text-align: left; font-size: 12px; font-weight: normal;" width="15%"><span>Account Name: </span></td> <td style="font-size: 12px; font-weight: normal;" width="35%"><span><input id="account_name" type="text" name="account_name" /></span></td> </tr> <tr> <td style="text-align: left; font-size: 12px; font-weight: normal;" width="15%"><span>Mobile: </span></td> <td style="font-size: 12px; font-weight: normal;" width="35%"><span><input id="phone_mobile" type="text" name="phone_mobile" /></span></td> <td style="text-align: left; font-size: 12px; font-weight: normal;" width="15%"><span>Office Phone: </span></td> <td style="font-size: 12px; font-weight: normal;" width="35%"><span><input id="phone_work" type="text" name="phone_work" /></span></td> </tr> <tr> <td style="text-align: left; font-size: 12px; font-weight: normal;" width="15%"><span>Email Address: </span></td> <td style="font-size: 12px; font-weight: normal;" width="35%"><span><input id="email1" type="text" name="email1" onChange="validateEmailAdd();" /></span></td> <td style="text-align: left; font-size: 12px; font-weight: normal;" width="15%"><span>Website: </span></td> <td style="font-size: 12px; font-weight: normal;" width="35%"><span><input id="website" type="text" name="website" /></span></td> </tr> <tr style="color: #0069e1; font-family: Arial,Verdana,Helvetica,sans-serif; font-size: 18px; font-weight: bold; margin-bottom: 0px; margin-top: 0px;" align="center"> <td colspan="4">� </td> </tr> <tr align="center"> <td colspan="10"><input class="button" onClick="submit_form();" type="button" name="Submit" value="Submit" /></td> </tr> <tr> <td style="display: none;"><input id="campaign_id" type="hidden" name="campaign_id" value="26482887-e75d-8145-0c3d-53612d180080" /></td> </tr> <tr> <td style="display: none;"><input id="redirect_url" type="hidden" name="redirect_url" value="http://http://sagemonttest.com/VirtueDesk/thanks.html" /></td> </tr> <tr> <td style="display: none;"><input id="assigned_user_id" type="hidden" name="assigned_user_id" value="1" /></td> </tr> <tr> <td style="display: none;"><input id="req_id" type="hidden" name="req_id" value="last_name;" /></td> </tr> </tbody> </table> </form> <script type="text/javascript">// <![CDATA[ function submit_form(){ if(typeof(validateCaptchaAndSubmit)!='undefined'){ validateCaptchaAndSubmit(); }else{ check_webtolead_fields(); } } function check_webtolead_fields(){ if(document.getElementById('bool_id') != null){ var reqs=document.getElementById('bool_id').value; bools = reqs.substring(0,reqs.lastIndexOf(';')); var bool_fields = new Array(); var bool_fields = bools.split(';'); nbr_fields = bool_fields.length; for(var i=0;i<nbr_fields;i++){ if(document.getElementById(bool_fields[i]).value == 'on'){ document.getElementById(bool_fields[i]).value = 1; } else{ document.getElementById(bool_fields[i]).value = 0; } } } if(document.getElementById('req_id') != null){ var reqs=document.getElementById('req_id').value; reqs = reqs.substring(0,reqs.lastIndexOf(';')); var req_fields = new Array(); var req_fields = reqs.split(';'); nbr_fields = req_fields.length; var req = true; for(var i=0;i<nbr_fields;i++){ if(document.getElementById(req_fields[i]).value.length <=0 || document.getElementById(req_fields[i]).value==0){ req = false; break; } } if(req){ document.WebToLeadForm.submit(); return true; } else{ alert('Please provide all the required fields'); return false; } return false } else{ document.WebToLeadForm.submit(); } } function validateEmailAdd(){ if(document.getElementById('email1') && document.getElementById('email1').value.length >0) { if(document.getElementById('email1').value.match(/^\w+(['\.\-\+]?\w+)*@\w+([\.-]?\w+)*(\.\w{2,})+$/) == null){ alert('Not a valid email address'); } } if(document.getElementById('email2') && document.getElementById('email2').value.length >0) { if(document.getElementById('email2').value.match(/^\w+(['\.\-\+]?\w+)*@\w+([\.-]?\w+)*(\.\w{2,})+$/) == null){ alert('Not a valid email address'); } } } // ]]></script></body></html> </fieldset> </form> </div><!-- /.col-lg-12 --> </div><!-- /.row -->