| 1 | <html lang='en_us'><head><meta http-equiv="Content-Type" content="text/html; charset=UTF-8"></head><body><p>
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| 2 | <script type="text/javascript" src="https://eyeo.sugarondemand.com/cache/include/javascript/sugar_grp1.js?v=w5v4y6Q1cX-YoKlN5l2Nrw"></script>
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| 3 | </p>
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| 4 | <form id="WebToLeadForm" action="https://eyeo.sugarondemand.com/index.php?entryPoint=WebToLeadCapture" method="POST" name="WebToLeadForm">
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| 5 | <table style="border-top: 1px solid; border-bottom: 1px solid; padding: 10px 6px 12px 10px; background-color: #e9f3ff; font-size: 12px; background-repeat: repeat-x; background-position: center top; width: 100%;">
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| 6 | <tbody>
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| 7 | <tr style="color: #0069e1; font-family: Arial,Verdana,Helvetica,sans-serif; font-size: 18px; font-weight: bold; margin-bottom: 0px; margin-top: 0px;" align="center">
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| 8 | <td colspan="4">
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| 9 | <h2>Web to lead form for Campaign</h2>
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| 10 | </td>
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| 11 | </tr>
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| 12 | <tr style="color: #0069e1; font-family: Arial,Verdana,Helvetica,sans-serif; font-size: 2px; font-weight: normal; margin-bottom: 0px; margin-top: 0px;" align="center">
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| 13 | <td colspan="4"> </td>
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| 14 | </tr>
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| 15 | <tr style="color: #0069e1; font-family: Arial,Verdana,Helvetica,sans-serif; font-size: 12px; font-weight: normal; margin-bottom: 0px; margin-top: 0px;" align="left">
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| 16 | <td colspan="4">Submitting this form will create a lead and link with campaign</td>
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| 17 | </tr>
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| 18 | <tr style="color: #0069e1; font-family: Arial,Verdana,Helvetica,sans-serif; font-size: 8px; font-weight: normal; margin-bottom: 0px; margin-top: 0px;" align="center">
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| 19 | <td colspan="4"> </td>
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| 20 | </tr>
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| 21 | <tr>
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| 22 | <td style="text-align: left; font-size: 12px; font-weight: normal;" width="15%"><span>Partner Type: <span class="required" style="color: #ff0000;">*</span></span></td>
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| 23 | <td style="font-size: 12px; font-weight: normal;" width="35%"><span><select id="partner_type_c" name="partner_type_c" tabindex="1">
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| 24 | <option selected="selected" value="Publisher">Publisher</option>
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| 25 | <option value="Ad Network">Ad Network</option>
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| 26 | <option value="Ad Tech">Ad Tech Provider</option>
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| 27 | <option value="Advertiser">Advertiser</option>
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| 28 | </select></span></td>
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| 29 | <td style="text-align: left; font-size: 12px; font-weight: normal;" width="15%"><span> </span></td>
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| 30 | <td style="font-size: 12px; font-weight: normal;" width="35%"><span> </span></td>
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| 31 | </tr>
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| 32 | <tr>
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| 33 | <td style="text-align: left; font-size: 12px; font-weight: normal;" width="15%"><span>Company Name: </span></td>
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| 34 | <td style="font-size: 12px; font-weight: normal;" width="35%"><span><input id="account_name" type="text" name="account_name" /></span></td>
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| 35 | <td style="text-align: left; font-size: 12px; font-weight: normal;" width="15%"><span> </span></td>
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| 36 | <td style="font-size: 12px; font-weight: normal;" width="35%"><span> </span></td>
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| 37 | </tr>
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| 38 | <tr>
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| 39 | <td style="text-align: left; font-size: 12px; font-weight: normal;" width="15%"><span>First Name: <span class="required" style="color: #ff0000;">*</span></span></td>
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| 40 | <td style="font-size: 12px; font-weight: normal;" width="35%"><span><input id="first_name" type="text" name="first_name" /></span></td>
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| 41 | <td style="text-align: left; font-size: 12px; font-weight: normal;" width="15%"><span> </span></td>
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| 42 | <td style="font-size: 12px; font-weight: normal;" width="35%"><span> </span></td>
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| 43 | </tr>
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| 44 | <tr>
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| 45 | <td style="text-align: left; font-size: 12px; font-weight: normal;" width="15%"><span>Last Name: <span class="required" style="color: #ff0000;">*</span></span></td>
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| 46 | <td style="font-size: 12px; font-weight: normal;" width="35%"><span><input id="last_name" type="text" name="last_name" /></span></td>
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| 47 | <td style="text-align: left; font-size: 12px; font-weight: normal;" width="15%"><span> </span></td>
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| 48 | <td style="font-size: 12px; font-weight: normal;" width="35%"><span> </span></td>
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| 49 | </tr>
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| 50 | <tr>
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| 51 | <td style="text-align: left; font-size: 12px; font-weight: normal;" width="15%"><span>Job Title: </span></td>
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| 52 | <td style="font-size: 12px; font-weight: normal;" width="35%"><span><input id="title" type="text" name="title" /></span></td>
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| 53 | <td style="text-align: left; font-size: 12px; font-weight: normal;" width="15%"><span> </span></td>
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| 54 | <td style="font-size: 12px; font-weight: normal;" width="35%"><span> </span></td>
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| 55 | </tr>
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| 56 | <tr>
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| 57 | <td style="text-align: left; font-size: 12px; font-weight: normal;" width="15%"><span>Company Website: </span></td>
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| 58 | <td style="font-size: 12px; font-weight: normal;" width="35%"><span><input id="website" type="text" name="website" /></span></td>
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| 59 | <td style="text-align: left; font-size: 12px; font-weight: normal;" width="15%"><span> </span></td>
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| 60 | <td style="font-size: 12px; font-weight: normal;" width="35%"><span> </span></td>
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| 61 | </tr>
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| 62 | <tr>
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| 63 | <td style="text-align: left; font-size: 12px; font-weight: normal;" width="15%"><span>Email Address: <span class="required" style="color: #ff0000;">*</span></span></td>
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| 64 | <td style="font-size: 12px; font-weight: normal;" width="35%"><span><input id="email1" type="text" name="email1" onchange="validateEmailAdd();" /></span></td>
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| 65 | <td style="text-align: left; font-size: 12px; font-weight: normal;" width="15%"><span> </span></td>
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| 66 | <td style="font-size: 12px; font-weight: normal;" width="35%"><span> </span></td>
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| 67 | </tr>
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| 68 | <tr>
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| 69 | <td style="text-align: left; font-size: 12px; font-weight: normal;" width="15%"><span>Exact URL with acceptable ads: <span class="required" style="color: #ff0000;">*</span></span></td>
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| 70 | <td style="font-size: 12px; font-weight: normal;" width="35%"><span><input id="website_with_acceptable_ads_c" type="text" name="website_with_acceptable_ads_c" /></span></td>
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| 71 | <td style="text-align: left; font-size: 12px; font-weight: normal;" width="15%"><span> </span></td>
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| 72 | <td style="font-size: 12px; font-weight: normal;" width="35%"><span> </span></td>
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| 73 | </tr>
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| 74 | <tr>
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| 75 | <td style="text-align: left; font-size: 12px; font-weight: normal;" width="15%"><span>Exact second URL with acceptable ads: </span></td>
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| 76 | <td style="font-size: 12px; font-weight: normal;" width="35%"><span><input id="second_website_with_acc_ads_c" type="text" name="second_website_with_acc_ads_c" /></span></td>
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| 77 | <td style="text-align: left; font-size: 12px; font-weight: normal;" width="15%"><span> </span></td>
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| 78 | <td style="font-size: 12px; font-weight: normal;" width="35%"><span> </span></td>
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| 79 | </tr>
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| 80 | <tr>
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| 81 | <td style="text-align: left; font-size: 12px; font-weight: normal;" width="15%"><span>Exact third URL with acceptable ads: </span></td>
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| 82 | <td style="font-size: 12px; font-weight: normal;" width="35%"><span><input id="third_website_with_acc_ads_c" type="text" name="third_website_with_acc_ads_c" /></span></td>
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| 83 | <td style="text-align: left; font-size: 12px; font-weight: normal;" width="15%"><span> </span></td>
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| 84 | <td style="font-size: 12px; font-weight: normal;" width="35%"><span> </span></td>
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| 85 | </tr>
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| 86 | <tr>
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| 87 | <td style="text-align: left; font-size: 12px; font-weight: normal;" width="15%"><span>Comments: </span></td>
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| 88 | <td style="font-size: 12px; font-weight: normal;" width="35%"><span id="sugarslot"><textarea id="proposal_textbox_c" type="text" name="proposal_textbox_c" /> </textarea></span></td>
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| 89 | <td style="text-align: left; font-size: 12px; font-weight: normal;" width="15%"><span> </span></td>
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| 90 | <td style="font-size: 12px; font-weight: normal;" width="35%"><span> </span></td>
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| 91 | </tr>
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| 92 | <tr style="color: #0069e1; font-family: Arial,Verdana,Helvetica,sans-serif; font-size: 18px; font-weight: bold; margin-bottom: 0px; margin-top: 0px;" align="center">
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| 93 | <td colspan="4"> </td>
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| 94 | </tr>
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| 95 | <tr align="center">
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| 96 | <td colspan="10"><input class="button" onclick="submit_form();" type="button" name="Submit" value="Submit" /></td>
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| 97 | </tr>
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| 98 | <tr>
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| 99 | <td style="display: none;"><input id="campaign_id" type="hidden" name="campaign_id" value="40e41f0e-ee21-9243-b374-57319a53b6f1" /></td>
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| 100 | </tr>
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| 101 | <tr>
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| 102 | <td style="display: none;"><input id="assigned_user_id" type="hidden" name="assigned_user_id" value="652b2e55-db9d-c45d-e982-51e3ee13f0d8" /></td>
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| 103 | </tr>
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| 104 | <tr>
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| 105 | <td style="display: none;"><input id="team_id" type="hidden" name="team_id" value="1" /></td>
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| 106 | </tr>
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| 107 | <tr>
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| 108 | <td style="display: none;"><input id="team_set_id" type="hidden" name="team_set_id" value="Global" /></td>
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| 109 | </tr>
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| 110 | <tr>
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| 111 | <td style="display: none;"><input id="req_id" type="hidden" name="req_id" value="partner_type_c;first_name;last_name;email1;website_with_acceptable_ads_c;" /></td>
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| 112 | </tr>
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| 113 | </tbody>
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| 114 | </table>
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| 115 | </form>
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| 116 | <p>
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| 117 | <script type="text/javascript">// <![CDATA[
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| 118 | function submit_form(){
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| 119 | if(typeof(validateCaptchaAndSubmit)!='undefined'){
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| 120 | validateCaptchaAndSubmit();
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| 121 | }else{
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| 122 | check_webtolead_fields();
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| 123 | }
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| 124 | }
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| 125 | function check_webtolead_fields(){
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| 126 | if(document.getElementById('bool_id') != null){
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| 127 | var reqs=document.getElementById('bool_id').value;
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| 128 | bools = reqs.substring(0,reqs.lastIndexOf(';'));
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| 129 | var bool_fields = new Array();
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| 130 | var bool_fields = bools.split(';');
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| 131 | nbr_fields = bool_fields.length;
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| 132 | for(var i=0;i<nbr_fields;i++){
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| 133 | if(document.getElementById(bool_fields[i]).value == 'on'){
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| 134 | document.getElementById(bool_fields[i]).value = 1;
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| 135 | }
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| 136 | else{
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| 137 | document.getElementById(bool_fields[i]).value = 0;
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| 138 | }
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| 139 | }
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| 140 | }
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| 141 | if(document.getElementById('req_id') != null){
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| 142 | var reqs=document.getElementById('req_id').value;
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| 143 | reqs = reqs.substring(0,reqs.lastIndexOf(';'));
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| 144 | var req_fields = new Array();
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| 145 | var req_fields = reqs.split(';');
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| 146 | nbr_fields = req_fields.length;
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| 147 | var req = true;
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| 148 | for(var i=0;i<nbr_fields;i++){
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| 149 | if(document.getElementById(req_fields[i]).value.length <=0 || document.getElementById(req_fields[i]).value==0){
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| 150 | req = false;
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| 151 | break;
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| 152 | }
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| 153 | }
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| 154 | if(req){
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| 155 | document.WebToLeadForm.submit();
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| 156 | return true;
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| 157 | }
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| 158 | else{
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| 159 | alert('Please provide all the required fields');
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| 160 | return false;
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| 161 | }
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| 162 | return false
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| 163 | }
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| 164 | else{
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| 165 | document.WebToLeadForm.submit();
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| 166 | }
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| 167 | }
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| 168 | function validateEmailAdd(){
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| 169 | if(document.getElementById('email1') && document.getElementById('email1').value.length >0) {
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| 170 | if(document.getElementById('email1').value.match(/^\w+(['\.\-\+]?\w+)*@\w+([\.-]?\w+)*(\.\w{2,})+$/) == null){
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| 171 | alert('Not a valid email address');
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| 172 | }
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| 173 | }
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| 174 | if(document.getElementById('email2') && document.getElementById('email2').value.length >0) {
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| 175 | if(document.getElementById('email2').value.match(/^\w+(['\.\-\+]?\w+)*@\w+([\.-]?\w+)*(\.\w{2,})+$/) == null){
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| 176 | alert('Not a valid email address');
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| 177 | }
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| 178 | }
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| 179 | }
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| 180 | // ]]></script>
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| 181 | </p></body></html> |
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