<!-- 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' class='zcwf_lblLeft crmWebToEntityForm' style='background-color: white;color: black;max-width: 600px;'>
<meta name='viewport' content='width=device-width, initial-scale=1.0'>
<META HTTP-EQUIV ='content-type' CONTENT='text/html;charset=UTF-8'>
<form action='https://crm.zoho.eu/crm/WebToLeadForm' name=WebToLeads281450000000329015 method='POST' onSubmit='javascript:document.charset="UTF-8"; return checkMandatory281450000000329015()' accept-charset='UTF-8'>
<input type='text' style='display:none;' name='xnQsjsdp' value='b705daa99dd54ce2d347eaa8cefa7866ee22cd040f03b37e8a9ffc0cf0de15e0'></input>
<input type='hidden' name='zc_gad' id='zc_gad' value=''></input>
<input type='text' style='display:none;' name='xmIwtLD' value='bb53bca907187f92bc6970d88ce9642c3356187f217cb886f761ea65d0843dd6'></input>
<input type='text' style='display:none;' name='actionType' value='TGVhZHM='></input>
<input type='text' style='display:none;' name='returnURL' value='https://polophills.es/gracias' > </input>
<!-- Do not remove this code. -->
<input type='text' style='display:none;' id='ldeskuid' name='ldeskuid'></input>
<input type='text' style='display:none;' id='LDTuvid' name='LDTuvid'></input>
<!-- Do not remove this code. -->
<style>
html,body{
margin: 0px;
}
#crmWebToEntityForm.zcwf_lblLeft {
width:100%;
padding: 25px;
margin: 0 auto;
box-sizing: border-box;
}
#crmWebToEntityForm.zcwf_lblLeft * {
box-sizing: border-box;
}
#crmWebToEntityForm{text-align: left;}
#crmWebToEntityForm * {
direction: ltr;
}
.zcwf_lblLeft .zcwf_title {
word-wrap: break-word;
padding: 0px 6px 10px;
font-weight: bold;
}
.zcwf_lblLeft .zcwf_col_fld input[type=text], .zcwf_lblLeft .zcwf_col_fld textarea {
width: 60%;
border: 1px solid #ccc;
resize: vertical;
border-radius: 2px;
float: left;
}
.zcwf_lblLeft .zcwf_col_lab {
width: 30%;
word-break: break-word;
padding: 0px 6px 0px;
margin-right: 10px;
margin-top: 5px;
float: left;
min-height: 1px;
}
.zcwf_lblLeft .zcwf_col_fld {
float: left;
width: 68%;
padding: 0px 6px 0px;
position: relative;
margin-top: 5px;
}
.zcwf_lblLeft .zcwf_privacy{padding: 6px;}
.zcwf_lblLeft .wfrm_fld_dpNn{display: none;}
.dIB{display: inline-block;}
.zcwf_lblLeft .zcwf_col_fld_slt {
width: 60%;
border: 1px solid #ccc;
background: #fff;
border-radius: 4px;
font-size: 12px;
float: left;
resize: vertical;
}
.zcwf_lblLeft .zcwf_row:after, .zcwf_lblLeft .zcwf_col_fld:after {
content: '';
display: table;
clear: both;
}
.zcwf_lblLeft .zcwf_col_help {
float: left;
margin-left: 7px;
font-size: 12px;
max-width: 35%;
word-break: break-word;
}
.zcwf_lblLeft .zcwf_help_icon {
cursor: pointer;
width: 16px;
height: 16px;
display: inline-block;
background: #fff;
border: 1px solid #ccc;
color: #ccc;
text-align: center;
font-size: 11px;
line-height: 16px;
font-weight: bold;
border-radius: 50%;
}
.zcwf_lblLeft .zcwf_row {margin: 15px 0px;}
.zcwf_lblLeft .formsubmit {
margin-right: 5px;
cursor: pointer;
color: #333;
font-size: 12px;
}
.zcwf_lblLeft .zcwf_privacy_txt {
color: rgb(0, 0, 0);
font-size: 12px;
font-family: Arial;
display: inline-block;
vertical-align: top;
color: #333;
padding-top: 2px;
margin-left: 6px;
}
.zcwf_lblLeft .zcwf_button {
font-size: 12px;
color: #333;
border: 1px solid #ccc;
padding: 3px 9px;
border-radius: 4px;
cursor: pointer;
max-width: 120px;
overflow: hidden;
text-overflow: ellipsis;
white-space: nowrap;
}
.zcwf_lblLeft .zcwf_tooltip_over{
position: relative;
}
.zcwf_lblLeft .zcwf_tooltip_ctn{
position: absolute;
background: #dedede;
padding: 3px 6px;
top: 3px;
border-radius: 4px;word-break: break-all;
min-width: 50px;
max-width: 150px;
color: #333;
}
.zcwf_lblLeft .zcwf_ckbox{
float: left;
}
.zcwf_lblLeft .zcwf_file{
width: 55%;
box-sizing: border-box;
float: left;
}
.clearB:after{
content:'';
display: block;
clear: both;
}
@media all and (max-width: 600px) {
.zcwf_lblLeft .zcwf_col_lab, .zcwf_lblLeft .zcwf_col_fld {
width: auto;
float: none !important;
}
.zcwf_lblLeft .zcwf_col_help {width: 40%;}
}
</style>
<div class='zcwf_title' style='max-width: 600px;color: black;'>Formulario Web Comercial</div>
<div class='zcwf_row'><div class='zcwf_col_lab' style='font-size:12px; font-family: Arial;'><label for='First_Name'>Nombre</label></div><div class='zcwf_col_fld'><input type='text' id='First_Name' name='First Name' maxlength='40'></input><div class='zcwf_col_help'></div></div></div>
<div class='zcwf_row'><div class='zcwf_col_lab' style='font-size:12px; font-family: Arial;'><label for='Last_Name'>Apellidos<span style='color:red;'>*</span></label></div><div class='zcwf_col_fld'><input type='text' id='Last_Name' name='Last Name' maxlength='80'></input><div class='zcwf_col_help'></div></div></div>
<div class='zcwf_row'><div class='zcwf_col_lab' style='font-size:12px; font-family: Arial;'><label for='Email'>Correo electrónico</label></div><div class='zcwf_col_fld'><input type='text' ftype='email' id='Email' name='Email' maxlength='100'></input><div class='zcwf_col_help'></div></div></div>
<div class='zcwf_row'><div class='zcwf_col_lab' style='font-size:12px; font-family: Arial;'><label for='Mobile'>Móvil</label></div><div class='zcwf_col_fld'><input type='text' id='Mobile' name='Mobile' maxlength='30'></input><div class='zcwf_col_help'></div></div></div>
<div class='zcwf_row'><div class='zcwf_col_lab' style='font-size:12px; font-family: Arial;'><label for='Description'>Descripción</label></div><div class='zcwf_col_fld'><textarea id='Description' name='Description'></textarea><div class='zcwf_col_help'></div></div></div><div class='zcwf_row'><div class='zcwf_col_lab'></div><div class='zcwf_col_fld'><input type='submit' id='formsubmit' class='formsubmit zcwf_button' value='Enviar' title='Enviar'><input type='reset' class='zcwf_button' name='reset' value='Restablecer' title='Restablecer'></div></div>
<script>
function validateEmail281450000000329015()
{
var form = document.forms['WebToLeads281450000000329015'];
var emailFld = form.querySelectorAll('[ftype=email]');
var i;
for (i = 0; i < emailFld.length; i++)
{
var emailVal = emailFld[i].value;
if((emailVal.replace(/^\s+|\s+$/g, '')).length!=0 )
{
var atpos=emailVal.indexOf('@');
var dotpos=emailVal.lastIndexOf('.');
if (atpos<1 || dotpos<atpos+2 || dotpos+2>=emailVal.length)
{
alert('Introduzca una dirección de correo electrónico válida. ');
emailFld[i].focus();
return false;
}
}
}
return true;
}
function checkMandatory281450000000329015() {
var mndFileds = new Array('Last Name');
var fldLangVal = new Array('Apellidos');
for(i=0;i<mndFileds.length;i++) {
var fieldObj=document.forms['WebToLeads281450000000329015'][mndFileds[i]];
if(fieldObj) {
if (((fieldObj.value).replace(/^\s+|\s+$/g, '')).length==0) {
if(fieldObj.type =='file')
{
alert('Seleccione un archivo para cargar.');
fieldObj.focus();
return false;
}
alert(fldLangVal[i] +' no puede estar vacío.');
fieldObj.focus();
return false;
} else if(fieldObj.nodeName=='SELECT') {
if(fieldObj.options[fieldObj.selectedIndex].value=='-None-') {
alert(fldLangVal[i] +' no puede ser nulo.');
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) {}
}
}
trackVisitor();
if(!validateEmail281450000000329015()){return false;}
document.querySelector('.crmWebToEntityForm .formsubmit').setAttribute('disabled', true);
}
function tooltipShow281450000000329015(el){
var tooltip = el.nextElementSibling;
var tooltipDisplay = tooltip.style.display;
if(tooltipDisplay == 'none'){
var allTooltip = document.getElementsByClassName('zcwf_tooltip_over');
for(i=0; i<allTooltip.length; i++){
allTooltip[i].style.display='none';
}
tooltip.style.display = 'block';
}else{
tooltip.style.display='none';
}
}
</script><script type='text/javascript' id='VisitorTracking'>var $zoho= $zoho || {};$zoho.salesiq = $zoho.salesiq || {widgetcode:'bd1d0e24f478675010d5cf9b575eaae7ae01c6452169bcc9079b04fe23691e80875a5730575029253cfea3b8b1ff9be5', values:{},ready:function(){$zoho.salesiq.floatbutton.visible('hide');}};var d=document;s=d.createElement('script');s.type='text/javascript';s.id='zsiqscript';s.defer=true;s.src='https://salesiq.zoho.eu/widget';t=d.getElementsByTagName('script')[0];t.parentNode.insertBefore(s,t);function trackVisitor(){try{if($zoho){var LDTuvidObj = document.forms['WebToLeads281450000000329015']['LDTuvid'];if(LDTuvidObj){LDTuvidObj.value = $zoho.salesiq.visitor.uniqueid();}var firstnameObj = document.forms['WebToLeads281450000000329015']['First Name'];if(firstnameObj){name = firstnameObj.value +' '+name;}$zoho.salesiq.visitor.name(name);var emailObj = document.forms['WebToLeads281450000000329015']['Email'];if(emailObj){email = emailObj.value;$zoho.salesiq.visitor.email(email);}}} catch(e){}}</script>
<!-- Do not remove this --- Analytics Tracking code starts --><script id='wf_anal' src='https://crm.zohopublic.eu/crm/WebFormAnalyticsServeServlet?rid=bb53bca907187f92bc6970d88ce9642c3356187f217cb886f761ea65d0843dd6gidb705daa99dd54ce2d347eaa8cefa7866ee22cd040f03b37e8a9ffc0cf0de15e0gidd5d4836131045889aacd8ee89fe126degidc4408f450319003e0c12e54df63a8632'></script><!-- Do not remove this --- Analytics Tracking code ends. --></form>
</div>