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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