<!-- 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.--><!-- [et_pb_line_break_holder] --> <style><!-- [et_pb_line_break_holder] --> .entry-content tr td, body.et-pb-preview #main-content .container tr td {<!-- [et_pb_line_break_holder] --> border-top: none;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> .entry-content table, body.et-pb-preview #main-content .container table {<!-- [et_pb_line_break_holder] --> border: none;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> input, select, option, textarea{<!-- [et_pb_line_break_holder] --> font-size: 100%;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> .et_pb_reset_button, .et_pb_reset_button:visited {<!-- [et_pb_line_break_holder] --> background: rgba(0,0,0,.05) !important;<!-- [et_pb_line_break_holder] --> border: 4px solid transparent !important;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> .et_pb_reset_button:hover, .et_pb_reset_button:focus, .et_pb_reset_button:active {<!-- [et_pb_line_break_holder] --> background: rgba(0,0,0,.05) !important;<!-- [et_pb_line_break_holder] --> border: 4px solid #5f3f5e !important;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> </style><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <div id="crmWebToEntityForm" style="width: 600px; margin: auto;"><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <form accept-charset="UTF-8" action="https://crm.zoho.com/crm/WebToLeadForm" method="post" name="WebToLeads1033609000000166366" id="WebToLeads1033609000000166366"><!-- [et_pb_line_break_holder] --> <table style="width: 600px;"><!-- [et_pb_line_break_holder] --> <tbody><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td style="text-align: left;" colspan="2"><!-- [et_pb_line_break_holder] --> <h1><!-- [et_pb_line_break_holder] --> Mailing List<!-- [et_pb_line_break_holder] --> </h1><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td style="nowrap: nowrap;"><!-- [et_pb_line_break_holder] --> First Name<!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="width: 250px;"><!-- [et_pb_line_break_holder] --> <input style="width: 100%;" maxlength="40" name="First Name" type="text"><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td style="nowrap: nowrap;"><!-- [et_pb_line_break_holder] --> Last Name <span class='purple'>*</span><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="width: 250px;"><!-- [et_pb_line_break_holder] --> <input style="width: 100%;" maxlength="80" name="Last Name" type="text"><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td style="nowrap: nowrap;"><!-- [et_pb_line_break_holder] --> Email <span class='purple'>*</span><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="width: 250px;"><!-- [et_pb_line_break_holder] --> <input style="width: 100%;" maxlength="100" name="Email" type="text"><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td style="nowrap: nowrap;"><!-- [et_pb_line_break_holder] --> I'm interested in <span class='purple'>*</span><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="width: 250px;"><!-- [et_pb_line_break_holder] --> <select style="width: 100%;" multiple="multiple" name="LEADCF5"><!-- [et_pb_line_break_holder] --> <option selected="selected" value="Wedding dress"><!-- [et_pb_line_break_holder] --> Wedding dress<!-- [et_pb_line_break_holder] --> </option><!-- [et_pb_line_break_holder] --> <option value="Bridesmaid Dress"><!-- [et_pb_line_break_holder] --> Bridesmaid Dress<!-- [et_pb_line_break_holder] --> </option><!-- [et_pb_line_break_holder] --> <option value="Alterations"><!-- [et_pb_line_break_holder] --> Alterations<!-- [et_pb_line_break_holder] --> </option><!-- [et_pb_line_break_holder] --> <option value="Accessories"><!-- [et_pb_line_break_holder] --> Accessories<!-- [et_pb_line_break_holder] --> </option><!-- [et_pb_line_break_holder] --> </select><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td style="nowrap: nowrap;"><!-- [et_pb_line_break_holder] --> Wedding Date <span class='purple'>*</span><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="width: 250px;"><!-- [et_pb_line_break_holder] --> <input style="width: 100%;" maxlength="20" name="LEADCF81" type="text" placeholder="dd/MM/yyyy"><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td style="nowrap: nowrap;"><!-- [et_pb_line_break_holder] --> Approximate budget <span class='purple'>*</span><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="width: 250px;"><!-- [et_pb_line_break_holder] --> <select style="width: 100%;" name="LEADCF2"><!-- [et_pb_line_break_holder] --> <option value="-None-"><!-- [et_pb_line_break_holder] --> -None-<!-- [et_pb_line_break_holder] --> </option><!-- [et_pb_line_break_holder] --> <option value="Less than $1000"><!-- [et_pb_line_break_holder] --> Less than $1000<!-- [et_pb_line_break_holder] --> </option><!-- [et_pb_line_break_holder] --> <option value="Less than $1500"><!-- [et_pb_line_break_holder] --> Less than $1500<!-- [et_pb_line_break_holder] --> </option><!-- [et_pb_line_break_holder] --> <option value="Less than $2000"><!-- [et_pb_line_break_holder] --> Less than $2000<!-- [et_pb_line_break_holder] --> </option><!-- [et_pb_line_break_holder] --> <option value="$2000+"><!-- [et_pb_line_break_holder] --> $2000+<!-- [et_pb_line_break_holder] --> </option><!-- [et_pb_line_break_holder] --> </select><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style="display: none;"><!-- [et_pb_line_break_holder] --> <td style="nowrap: nowrap; text-align: left; font-size: 12px; font-family: Arial; width: 50%;"><!-- [et_pb_line_break_holder] --> Lead Source<!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="width: 250px;"><!-- [et_pb_line_break_holder] --> <select style="width: 100%;" name="Lead Source"><!-- [et_pb_line_break_holder] --> <option value="-None-"><!-- [et_pb_line_break_holder] --> None<!-- [et_pb_line_break_holder] --> </option><!-- [et_pb_line_break_holder] --> <option value="Website"><!-- [et_pb_line_break_holder] --> Website<!-- [et_pb_line_break_holder] --> </option><!-- [et_pb_line_break_holder] --> <option value="Phone/Email"><!-- [et_pb_line_break_holder] --> Phone/Email<!-- [et_pb_line_break_holder] --> </option><!-- [et_pb_line_break_holder] --> <option value="Walk-in"><!-- [et_pb_line_break_holder] --> Walk-in<!-- [et_pb_line_break_holder] --> </option><!-- [et_pb_line_break_holder] --> <option value="Wedding Palace Jan 2014"><!-- [et_pb_line_break_holder] --> Wedding Palace Jan 2014<!-- [et_pb_line_break_holder] --> </option><!-- [et_pb_line_break_holder] --> <option value="Tip Top Tailors"><!-- [et_pb_line_break_holder] --> Tip Top Tailors<!-- [et_pb_line_break_holder] --> </option><!-- [et_pb_line_break_holder] --> <option value="Wedding Palace Sept 2014"><!-- [et_pb_line_break_holder] --> Wedding Palace Sept 2014<!-- [et_pb_line_break_holder] --> </option><!-- [et_pb_line_break_holder] --> <option value="Renewed With Love"><!-- [et_pb_line_break_holder] --> Renewed With Love<!-- [et_pb_line_break_holder] --> </option><!-- [et_pb_line_break_holder] --> <option value="Consignment"><!-- [et_pb_line_break_holder] --> Consignment<!-- [et_pb_line_break_holder] --> </option><!-- [et_pb_line_break_holder] --> <option value="Renewed_Adwords"><!-- [et_pb_line_break_holder] --> Renewed_Adwords<!-- [et_pb_line_break_holder] --> </option><!-- [et_pb_line_break_holder] --> <option value="Wedding Palace Jan 2015"><!-- [et_pb_line_break_holder] --> Wedding Palace Jan 2015<!-- [et_pb_line_break_holder] --> </option><!-- [et_pb_line_break_holder] --> <option value="Renewed Wedding Palace Fall 2016"><!-- [et_pb_line_break_holder] --> Renewed Wedding Palace Fall 2016<!-- [et_pb_line_break_holder] --> </option><!-- [et_pb_line_break_holder] --> <option value="WL Wedding Palace Fall 2016"><!-- [et_pb_line_break_holder] --> WL Wedding Palace Fall 2016<!-- [et_pb_line_break_holder] --> </option><!-- [et_pb_line_break_holder] --> <option selected="selected" value="Mailing List"><!-- [et_pb_line_break_holder] --> Mailing List<!-- [et_pb_line_break_holder] --> </option><!-- [et_pb_line_break_holder] --> </select><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td style="text-align: center; padding-top: 15px;" colspan="2"><!-- [et_pb_line_break_holder] --> <input style="margin-right:50px" type="submit" value="Submit" class='et_pb_button et_pb_button_0 et_pb_module et_pb_bg_layout_light'><!-- [et_pb_line_break_holder] --> <input class='et_pb_reset_button et_pb_button et_pb_button_0 et_pb_module et_pb_bg_layout_light' type="reset" value="Reset"><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> </tbody><!-- [et_pb_line_break_holder] --> </table><script type="text/javascript"><!-- [et_pb_line_break_holder] -->var mndFileds=new Array('Last Name','Email','LEADCF5','LEADCF81','LEADCF2');<!-- [et_pb_line_break_holder] --> var fldLangVal=new Array('Last Name','Email','I\'m interested in','Wedding Date','Approximate budget');<!-- [et_pb_line_break_holder] --> var name='';<!-- [et_pb_line_break_holder] --> var email='';<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> function checkMandatory() {<!-- [et_pb_line_break_holder] --> for(i=0;i<mndFileds.length;i++) {<!-- [et_pb_line_break_holder] --> var fieldObj=document.forms['WebToLeads1033609000000166366'][mndFileds[i]];<!-- [et_pb_line_break_holder] --> if(fieldObj) {<!-- [et_pb_line_break_holder] --> if (((fieldObj.value).replace(/^\s+|\s+$/g, '')).length==0) {<!-- [et_pb_line_break_holder] --> if(fieldObj.type =='file')<!-- [et_pb_line_break_holder] --> { <!-- [et_pb_line_break_holder] --> alert('Please select a file to upload.'); <!-- [et_pb_line_break_holder] --> fieldObj.focus(); <!-- [et_pb_line_break_holder] --> return false;<!-- [et_pb_line_break_holder] --> } <!-- [et_pb_line_break_holder] --> alert(fldLangVal[i] +' cannot be empty.'); <!-- [et_pb_line_break_holder] --> fieldObj.focus();<!-- [et_pb_line_break_holder] --> return false;<!-- [et_pb_line_break_holder] --> } else if(fieldObj.nodeName=='SELECT') {<!-- [et_pb_line_break_holder] --> if(fieldObj.options[fieldObj.selectedIndex].value=='-None-') {<!-- [et_pb_line_break_holder] --> alert(fldLangVal[i] +' cannot be none.'); <!-- [et_pb_line_break_holder] --> fieldObj.focus();<!-- [et_pb_line_break_holder] --> return false;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> } else if(fieldObj.type =='checkbox'){<!-- [et_pb_line_break_holder] --> if(fieldObj.checked == false){<!-- [et_pb_line_break_holder] --> alert('Please accept '+fldLangVal[i]);<!-- [et_pb_line_break_holder] --> fieldObj.focus();<!-- [et_pb_line_break_holder] --> return false;<!-- [et_pb_line_break_holder] --> } <!-- [et_pb_line_break_holder] --> } <!-- [et_pb_line_break_holder] --> try {<!-- [et_pb_line_break_holder] --> if(fieldObj.name == 'Last Name') {<!-- [et_pb_line_break_holder] --> name = fieldObj.value;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> } catch (e) {}<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> </script><!-- [et_pb_line_break_holder] --> </form><!-- [et_pb_line_break_holder] --> </div>