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test lead form Hamza

Submitting this form will create Leads

Description:

Salutation: --None-- Mr. Ms. Mrs. Miss Dr. Prof.

First Name:

Last Name: *

Job Title:

Department:

Do Not Call:

Home Phone:

Mobile:

Office Phone:

Other Phone:

Fax:

Email Address:

Other Email:

Lawful Basis: --None-- Consent Contract Legal obligation Protection of interest Public interest Legitimate interest Withdrawn

Lawful Basis Date Reviewed:

Lawful Basis Source: --None-- Website Phone Given to User Email Third Party

Primary Address Street:

Primary Address City:

Primary Address State:

Primary Address Postalcode:

Primary Address Country:

Alt Address Street:

Alt Address City:

Alt Address State:

Alt Address Postalcode:

Alt Address Country:

Assistant:

Assistant Phone:

Referred By:

Lead Source: --None-- Cold Call Existing Customer Self Generated Employee Partner Public Relations Direct Mail Conference Trade Show Web Site Word of mouth Email Campaign Other Landing Page

Lead Source Description:

Status: --None-- New Assigned In Process Converted Recycled Dead Mailer

Status Description:

Account Name:

Account Description:

Opportunity Name:

Opportunity Amount:

Birthdate:

Portal Name:

Portal Application:

Website:

Geocode Status:

Address:

function submit_form() { if (typeof(validateCaptchaAndSubmit) != 'undefined') { validateCaptchaAndSubmit(); } else { check_webtolead_fields(); //document.WebToLeadForm.submit(); } } 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; } } } }