<!-- 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=WebToLeads3843940000002488001 method='POST' onSubmit='javascript:document.charset="UTF-8"; return checkMandatory3843940000002488001()' accept-charset='UTF-8'><!-- [et_pb_line_break_holder] --> <input type='text' style='display:none;' name='xnQsjsdp' value='40f1ffc43687a312c2108f6f80ec1ba86116cfa40c7f528f5f1e7d703a70b99e'></input> <!-- [et_pb_line_break_holder] --> <input type='hidden' name='zc_gad' id='zc_gad' value=''></input> <!-- [et_pb_line_break_holder] --> <input type='text' style='display:none;' name='xmIwtLD' value='7b0ff1d931cd774d427fa58e639155ea8858660cf01ffd66bf195d362f0ce829'></input> <!-- [et_pb_line_break_holder] --> <input type='text' style='display:none;' name='actionType' value='TGVhZHM='></input><!-- [et_pb_line_break_holder] --> <input type='text' style='display:none;' name='returnURL' value='https://www.vivepolanco.mx' > </input><br></br><!-- [et_pb_line_break_holder] --> <!-- Do not remove this code. --><!-- [et_pb_line_break_holder] --> <style><!-- [et_pb_line_break_holder] --> #crmWebToEntityForm tr , #crmWebToEntityForm 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:#ffffff;background-color:white;color:black'><tr><td colspan='2' align='left' style='color:black;font-family:Arial;font-size:14px;word-break: break-word;'><strong>Vive Agent Form</strong></td></tr> <br></br><tr><td style='word-break: break-word;text-align:left;font-size:12px;font-family:Arial;width:30%;'>First Name<span style='color:red;'>*</span></td><td style='width:40%;' ><input type='text' style='width:100%;box-sizing:border-box;' maxlength='40' name='First Name' /></td><td style='width:30%;'></td></tr><tr><td style='word-break: break-word;text-align:left;font-size:12px;font-family:Arial;width:30%;'>Last Name<span style='color:red;'>*</span></td><td style='width:40%;' ><input type='text' style='width:100%;box-sizing:border-box;' maxlength='80' name='Last Name' /></td><td style='width:30%;'></td></tr><tr><td style='word-break: break-word;text-align:left;font-size:12px;font-family:Arial;width:30%;'>Email<span style='color:red;'>*</span></td><td style='width:40%;' ><input type='text' style='width:100%;box-sizing:border-box;' maxlength='100' name='Email' /></td><td style='width:30%;'></td></tr><tr><td style='word-break: break-word;text-align:left;font-size:12px;font-family:Arial;width:30%;'>Phone<span style='color:red;'>*</span></td><td style='width:40%;' ><input type='text' style='width:100%;box-sizing:border-box;' maxlength='30' name='Phone' /></td><td style='width:30%;'></td></tr><tr><td style='word-break: break-word;text-align:left;font-size:12px;font-family:Arial;width:30%;'>Description </td><td style='width:40%;'> <textarea name='Description' maxlength='32000' style='width:100%;'> </textarea></td><td style='width:30%;'></td></tr><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <tr><td colspan='2' style='text-align:center; padding-top:15px;font-size:12px;'><!-- [et_pb_line_break_holder] --> <input style='margin-right: 5px;cursor: pointer;font-size:12px;color:black' id='formsubmit' type='submit' value='Submit' ></input> <input type='reset' name='reset' style='cursor: pointer;font-size:12px;color:black' value='Reset' ></input> </td></tr></table><!-- [et_pb_line_break_holder] --> <script><!-- [et_pb_line_break_holder] --> var mndFileds=new Array('First Name','Last Name','Email','Phone');<!-- [et_pb_line_break_holder] --> var fldLangVal=new Array('First Name','Last Name','Email','Phone'); <!-- [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 checkMandatory3843940000002488001() {<!-- [et_pb_line_break_holder] --> for(i=0;i<mndFileds.length;i++) {<!-- [et_pb_line_break_holder] --> var fieldObj=document.forms['WebToLeads3843940000002488001'][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] --> document.getElementById('formsubmit').disabled=true;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --></script><!-- [et_pb_line_break_holder] --> </form><!-- [et_pb_line_break_holder] --></div>