<!– 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.–>
<div id=’crmWebToEntityForm’ style=’width:600px;margin:auto;’>
<META HTTP-EQUIV =’content-type’ CONTENT=’text/html;charset=UTF-8′>
<form action=’https://crm.zoho.com/crm/WebToLeadForm’ name=WebToLeads2547366000000959005 method=’POST’ onSubmit=’javascript:document.charset=”UTF-8″; return checkMandatory()’ accept-charset=’UTF-8′>

<!– Do not remove this code. –>
<input type=’text’ style=’display:none;’ name=’xnQsjsdp’ value=’d7ca250e7ffe3e8fd1e251303fb9367692dbc7a7e6d01abb17fd26b2c4fa22f3’/>
<input type=’hidden’ name=’zc_gad’ id=’zc_gad’ value=”/>
<input type=’text’ style=’display:none;’ name=’xmIwtLD’ value=’bbbf7e7601e34a9afda0064af38e9856f7eea431e28e16696cb804ce6ca6dc01’/>
<input type=’text’ style=’display:none;’ name=’actionType’ value=’TGVhZHM=’/>

<input type=’text’ style=’display:none;’ name=’returnURL’ value=’http&#x3a;&#x2f;&#x2f;lubehouse.com.pk&#x2f;win-a-free-lube-test&#x2f;’ />
<!– Do not remove this code. –>
<style>
tr , td {
padding:6px;
border-spacing:0px;
border-width:0px;
}
</style>
<table style=’width:600px;background-color:white;color:black’>

<tr><td colspan=’2′ style=’text-align:left;color:black;font-family:Arial;font-size:14px;’><strong>Requirements Form</strong></td></tr>

<tr><td style=’nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;’>Company<span style=’color:red;’>*</span></td><td style=’width:250px;’ ><input type=’text’ style=’width:250px;’ maxlength=’100′ name=’Company’ /></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 type=’text’ style=’width:250px;’ maxlength=’40’ name=’First Name’ /></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 type=’text’ style=’width:250px;’ maxlength=’80’ name=’Last Name’ /></td></tr>

<tr><td style=’nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;’>Title</td><td style=’width:250px;’ ><input type=’text’ style=’width:250px;’ maxlength=’100′ name=’Designation’ /></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 type=’text’ style=’width:250px;’ maxlength=’100′ name=’Email’ /></td></tr>

<tr><td style=’nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;’>Industry</td><td style=’width:250px;’>
<select style=’width:250px;’ name=’Industry’>
<option value=’-None-‘>None</option>
<option value=’Textile&#x20;Dying&#x20;&amp;&#x20;Finishing’>Textile Dying &amp; Finishing</option>
<option value=’Textile&#x20;Spinning’>Textile Spinning</option>
<option value=’Auto&#x20;Parts’>Auto Parts</option>
<option value=’Chemical&#x20;&amp;&#x20;Pharma’>Chemical &amp; Pharma</option>
<option value=’Leather’>Leather</option>
<option value=’General&#x20;Manufacturing’>General Manufacturing</option>
<option value=’Construction’>Construction</option>
<option value=’Food&#x20;&amp;&#x20;Beverage’>Food &amp; Beverage</option>
<option value=’Plastic&#x20;and&#x20;Mold’>Plastic and Mold</option>
<option value=’Electronics’>Electronics</option>
<option value=’Paper&#x20;&amp;&#x20;Board’>Paper &amp; Board</option>
<option value=’Printing&#x20;Press’>Printing Press</option>
<option value=’Power&#x20;and&#x20;Energy’>Power and Energy</option>
<option value=’Dairies’>Dairies</option>
<option value=’Steal&#x20;and&#x20;Metal’>Steal and Metal</option>
<option value=’Ghee&#x20;&amp;&#x20;Vegetables’>Ghee &amp; Vegetables</option>
<option value=’Polymers&#x20;&amp;&#x20;Films’>Polymers &amp; Films</option>
<option value=’Poultry&#x20;&amp;&#x20;Feed’>Poultry &amp; Feed</option>
</select></td></tr>

<tr><td style=’nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;’>Operational Area</td><td style=’width:250px;’>
<select style=’width:250px;’ name=’LEADCF1′>
<option value=’-None-‘>-None-</option>
<option value=’Shekupura’>Shekupura</option>
<option value=’Ferozpur&#x20;Road’>Ferozpur Road</option>
<option value=’Kotlakhpat’>Kotlakhpat</option>
<option value=’Sundar’>Sundar</option>
<option value=’Raiwind&#x20;&#x2f;Manga’>Raiwind &#x2f;Manga</option>
<option value=’GT&#x20;Road&#x20;&#x2f;Central’>GT Road &#x2f;Central</option>
</select></td></tr>

<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>

<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>

<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>

<tr><td style=’nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;’>Description </td><td> <textarea name=’Description’ maxlength=’1000′ style=’width:250px;’>&nbsp;</textarea></td></tr>

<tr><td style=’nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;’>Annual Demand</td><td style=’width:250px;’ ><input type=’text’ style=’width:250px;’ maxlength=’9′ name=’LEADCF51′ /></td></tr>

<tr><td colspan=’2′ style=’text-align:center; padding-top:15px;’>
<input style=’font-size:12px;color:#131307′ type=’submit’ value=’Submit’ />
<input type=’reset’ style=’font-size:12px;color:#131307′ value=’Reset’ />
</td>
</tr>
</table>
<script>
var mndFileds=new Array(‘Company’,’First Name’,’Last Name’);
var fldLangVal=new Array(‘Company’,’First Name’,’Last Name’);
var name=”;
var email=”;

function checkMandatory() {
for(i=0;i<mndFileds.length;i++) {
var fieldObj=document.forms[‘WebToLeads2547366000000959005′][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>
</div>