<div id=”crmWebToEntityForm” style=”width: 600px; margin: auto;”><form accept-charset=”UTF-8″ action=”https://crm.zoho.com/crm/WebToLeadForm” method=”POST” name=”WebToLeads761125000001913001″>
<table style=”width: 600px; background-color: white; color: black;”>
<tbody>
<tr>
<td style=”text-align: left; color: black; font-family: Arial; font-size: 14px;” colspan=”2″><strong>Contact Form</strong></td>
</tr>
<tr style=”display: none;”>
<td style=”nowrap: nowrap; text-align: left; font-size: 12px; font-family: Arial; width: 50%;”>Supplier Name</td>
<td style=”width: 250px;”><select style=”width: 250px;” name=”LEADCF6″>
<option value=”-None-“>-None-</option>
<option value=”D’Avino”>D’Avino</option>
<option value=”Babcock Commercial”>Babcock Commercial</option>
<option selected=”selected” value=”Samsung North”>Samsung North</option>
</select></td>
</tr>
<tr>
<td style=”nowrap: nowrap; text-align: left; font-size: 12px; font-family: Arial; width: 200px;”>First Name<span style=”color: red;”>*</span></td>
<td style=”width: 250px;”><input style=”width: 250px;” maxlength=”40″ name=”First Name” type=”text” /></td>
</tr>
<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 style=”width: 250px;” maxlength=”80″ name=”Last Name” type=”text” /></td>
</tr>
<tr>
<td style=”nowrap: nowrap; text-align: left; font-size: 12px; font-family: Arial; width: 200px;”>Company</td>
<td style=”width: 250px;”><input style=”width: 250px;” maxlength=”100″ name=”Company” type=”text” /></td>
</tr>
<tr>
<td style=”nowrap: nowrap; text-align: left; font-size: 12px; font-family: Arial; width: 200px;”>City<span style=”color: red;”>*</span></td>
<td style=”width: 250px;”><input style=”width: 250px;” maxlength=”30″ name=”City” type=”text” /></td>
</tr>
<tr>
<td style=”nowrap: nowrap; text-align: left; font-size: 12px; font-family: Arial; width: 200px;”>Phone<span style=”color: red;”>*</span></td>
<td style=”width: 250px;”><input style=”width: 250px;” maxlength=”30″ name=”Phone” type=”text” /></td>
</tr>
<tr>
<td style=”nowrap: nowrap; text-align: left; font-size: 12px; font-family: Arial; width: 200px;”>Fax</td>
<td style=”width: 250px;”><input style=”width: 250px;” maxlength=”30″ name=”Fax” type=”text” /></td>
</tr>
<tr>
<td style=”nowrap: nowrap; text-align: left; font-size: 12px; font-family: Arial; width: 200px;”>Email</td>
<td style=”width: 250px;”><input style=”width: 250px;” maxlength=”100″ name=”Email” type=”text” /></td>
</tr>
<tr>
<td style=”nowrap: nowrap; text-align: left; font-size: 12px; font-family: Arial; width: 200px;”>Office Automation Requirements</td>
<td style=”width: 250px;”><select style=”width: 250px;” multiple=”multiple” name=”LEADCF36″>
<option value=”Printer/Copier”>Printer/Copier</option>
<option value=”Rental”>Rental</option>
<option value=”Maintenance Plan”>Maintenance Plan</option>
<option value=”Printing Solutions”>Printing Solutions</option>
</select></td>
</tr>
<tr>
<td style=”nowrap: nowrap; text-align: left; font-size: 12px; font-family: Arial; width: 200px;”>Message</td>
<td><textarea style=”width: 250;” maxlength=”2000″ name=”LEADCF7″>&nbsp;</textarea></td>
</tr>
<tr>
<td style=”nowrap: nowrap; text-align: left; font-size: 12px; font-family: Arial; width: 200px;”>Enter the Captcha</td>
<td><input style=”width: 250px;” maxlength=”80″ name=”enterdigest” type=”text” /></td>
</tr>
<tr>
<td></td>
<!– Do not remove this code. –>
<td><img id=”imgid” src=”https://crm.zoho.com/crm/CaptchaServlet?formId=5bddc7e68810da86e028fc092bb2c64b1e7edf8ae819d86c99c21080212e4e28&amp;grpid=a9b53ef928e0d34fe6ebfee6df0c84e727fe2f290e22795a3622c39053854599″ alt=”” />
<a>Reload</a></td>
</tr>
<tr>
<td style=”text-align: center; padding-top: 15px;” colspan=”2″><input style=”font-size: 12px; color: #131307;” type=”submit” value=”Submit” />
<input style=”font-size: 12px; color: #131307;” type=”reset” value=”Reset” /></td>
</tr>
</tbody>
</table>
<script>// <![CDATA[
var mndFileds=new Array(‘First Name’,’Last Name’,’Phone’,’City’);
var fldLangVal=new Array(‘First Name’,’Last Name’,’Phone’,’City’);
var name=”;
var email=”;

/* Do not remove this code. */
function reloadImg() {
if(document.getElementById(‘imgid’).src.indexOf(‘&d’) !== -1 ) {
document.getElementById(‘imgid’).src=document.getElementById(‘imgid’).src.substring(0,document.getElementById(‘imgid’).src.indexOf(‘&d’))+’&d’+new Date().getTime();
}  else {
document.getElementById(‘imgid’).src = document.getElementById(‘imgid’).src+’&d’+new Date().getTime();
}
}

function checkMandatory() {
for(i=0;i<mndFileds.length;i++) { var fieldObj=document.forms[‘WebToLeads761125000001913001′][mndFileds[i]]; if(fieldObj) { if (((fieldObj.value).replace(/^\s+|\s+$/g, ”)).length==0) { if(fieldObj.type ==’file’) { alert(‘Please select a file to upload’); fieldObj.focus(); return false; } alert(fldLangVal[i] +’ cannot be empty’); fieldObj.focus(); return false; } else if(fieldObj.nodeName==’SELECT’) { if(fieldObj.options[fieldObj.selectedIndex].value==’-None-‘) { alert(fldLangVal[i] +’ cannot be none’); fieldObj.focus(); return false; } } else if(fieldObj.type ==’checkbox’){ if(fieldObj.checked == false){ alert(‘Please accept ‘+fldLangVal[i]); fieldObj.focus(); return false; } } try { if(fieldObj.name == ‘Last Name’) { name = fieldObj.value; } } catch (e) {} } } }
// ]]></script>

</form><!– Do not remove this code. –>
<iframe style=”display: none;” name=”captchaFrame” width=”300″ height=”150″></iframe>

</div>
<!– Note : – You can modify the font style and form style to suit your website. – 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. – The Mandatory check script can modified as to suit your business needs. – It is important that you test the modified form before going live. – Do not remove captcha and other form elements that are necessary for the form to work. –>
<div id=”crmWebToEntityForm” style=”width: 600px; margin: auto;”><form accept-charset=”UTF-8″ action=”https://crm.zoho.com/crm/WebToLeadForm” method=”POST” name=”WebToLeads761125000001913001″><!– Do not remove this code. –>
<input style=”display: none;” name=”xnQsjsdp” type=”text” value=”a9b53ef928e0d34fe6ebfee6df0c84e727fe2f290e22795a3622c39053854599″ />
<input id=”zc_gad” name=”zc_gad” type=”hidden” value=”” />
<input style=”display: none;” name=”xmIwtLD” type=”text” value=”5bddc7e68810da86e028fc092bb2c64b1e7edf8ae819d86c99c21080212e4e28″ />
<input style=”display: none;” name=”actionType” type=”text” value=”TGVhZHM=” /><input style=”display: none;” name=”returnURL” type=”text” value=”https://samsungnorth.co.za” />
<!– Do not remove this code. –>
<table style=”width: 600px; background-color: white; color: black;”>
<tbody>
<tr>
<td style=”text-align: left; color: black; font-family: Arial; font-size: 14px;” colspan=”2″><strong>Rental Contact Form</strong></td>
</tr>
<tr style=”display: none;”>
<td style=”nowrap: nowrap; text-align: left; font-size: 12px; font-family: Arial; width: 50%;”>Supplier Name</td>
<td style=”width: 250px;”><select style=”width: 250px;” name=”LEADCF6″>
<option value=”-None-“>-None-</option>
<option value=”D’Avino”>D’Avino</option>
<option value=”Babcock Commercial”>Babcock Commercial</option>
<option selected=”selected” value=”Samsung North”>Samsung North</option>
</select></td>
</tr>
<tr>
<td style=”nowrap: nowrap; text-align: left; font-size: 12px; font-family: Arial; width: 200px;”>First Name<span style=”color: red;”>*</span></td>
<td style=”width: 250px;”><input style=”width: 250px;” maxlength=”40″ name=”First Name” type=”text” /></td>
</tr>
<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 style=”width: 250px;” maxlength=”80″ name=”Last Name” type=”text” /></td>
</tr>
<tr>
<td style=”nowrap: nowrap; text-align: left; font-size: 12px; font-family: Arial; width: 200px;”>Company</td>
<td style=”width: 250px;”><input style=”width: 250px;” maxlength=”100″ name=”Company” type=”text” /></td>
</tr>
<tr>
<td style=”nowrap: nowrap; text-align: left; font-size: 12px; font-family: Arial; width: 200px;”>City<span style=”color: red;”>*</span></td>
<td style=”width: 250px;”><input style=”width: 250px;” maxlength=”30″ name=”City” type=”text” /></td>
</tr>
<tr>
<td style=”nowrap: nowrap; text-align: left; font-size: 12px; font-family: Arial; width: 200px;”>Phone<span style=”color: red;”>*</span></td>
<td style=”width: 250px;”><input style=”width: 250px;” maxlength=”30″ name=”Phone” type=”text” /></td>
</tr>
<tr>
<td style=”nowrap: nowrap; text-align: left; font-size: 12px; font-family: Arial; width: 200px;”>Fax</td>
<td style=”width: 250px;”><input style=”width: 250px;” maxlength=”30″ name=”Fax” type=”text” /></td>
</tr>
<tr>
<td style=”nowrap: nowrap; text-align: left; font-size: 12px; font-family: Arial; width: 200px;”>Email</td>
<td style=”width: 250px;”><input style=”width: 250px;” maxlength=”100″ name=”Email” type=”text” /></td>
</tr>
<tr>
<td style=”nowrap: nowrap; text-align: left; font-size: 12px; font-family: Arial; width: 200px;”>Office Automation Requirements</td>
<td style=”width: 250px;”><select style=”width: 250px;” multiple=”multiple” name=”LEADCF36″>
<option value=”Printer/Copier”>Printer/Copier</option>
<option value=”Rental”>Rental</option>
<option value=”Maintenance Plan”>Maintenance Plan</option>
<option value=”Printing Solutions”>Printing Solutions</option>
</select></td>
</tr>
<tr>
<td style=”nowrap: nowrap; text-align: left; font-size: 12px; font-family: Arial; width: 200px;”>Message</td>
<td><textarea style=”width: 250;” maxlength=”2000″ name=”LEADCF7″>&nbsp;</textarea></td>
</tr>
<tr>
<td style=”nowrap: nowrap; text-align: left; font-size: 12px; font-family: Arial; width: 200px;”>Enter the Captcha</td>
<td><input style=”width: 250px;” maxlength=”80″ name=”enterdigest” type=”text” /></td>
</tr>
<tr>
<td></td>
<!– Do not remove this code. –>
<td><img id=”imgid” src=”https://crm.zoho.com/crm/CaptchaServlet?formId=5bddc7e68810da86e028fc092bb2c64b1e7edf8ae819d86c99c21080212e4e28&amp;grpid=a9b53ef928e0d34fe6ebfee6df0c84e727fe2f290e22795a3622c39053854599″ alt=”” />
<a>Reload</a></td>
</tr>
<tr>
<td style=”text-align: center; padding-top: 15px;” colspan=”2″><input style=”font-size: 12px; color: #131307;” type=”submit” value=”Submit” />
<input style=”font-size: 12px; color: #131307;” type=”reset” value=”Reset” /></td>
</tr>
</tbody>
</table>
<script>// <![CDATA[
var mndFileds=new Array(‘First Name’,’Last Name’,’Phone’,’City’);
var fldLangVal=new Array(‘First Name’,’Last Name’,’Phone’,’City’);
var name=”;
var email=”;

/* Do not remove this code. */
function reloadImg() {
if(document.getElementById(‘imgid’).src.indexOf(‘&d’) !== -1 ) {
document.getElementById(‘imgid’).src=document.getElementById(‘imgid’).src.substring(0,document.getElementById(‘imgid’).src.indexOf(‘&d’))+’&d’+new Date().getTime();
}  else {
document.getElementById(‘imgid’).src = document.getElementById(‘imgid’).src+’&d’+new Date().getTime();
}
}

function checkMandatory() {
for(i=0;i<mndFileds.length;i++) { var fieldObj=document.forms[‘WebToLeads761125000001913001′][mndFileds[i]]; if(fieldObj) { if (((fieldObj.value).replace(/^\s+|\s+$/g, ”)).length==0) { alert(fldLangVal[i] +’ cannot be empty’); fieldObj.focus(); return false; } else if(fieldObj.nodeName==’SELECT’) { if(fieldObj.options[fieldObj.selectedIndex].value==’-None-‘) { alert(fldLangVal[i] +’ cannot be none’); fieldObj.focus(); return false; } } else if(fieldObj.type ==’checkbox’){ if(fieldObj.checked == false){ alert(‘Please accept ‘+fldLangVal[i]); fieldObj.focus(); return false; } } try { if(fieldObj.name == ‘Last Name’) { name = fieldObj.value; } } catch (e) {} } } }
// ]]></script>

</form><!– Do not remove this code. –>
<iframe style=”display: none;” name=”captchaFrame” width=”300″ height=”150″></iframe>

</div>

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