<!– ———————————————————————- –>
<!– NOTE: Please add the following <META> element to your page <HEAD>. –>
<!– If necessary, please modify the charset parameter to specify the –>
<!– character set of your HTML page. –>
<!– ———————————————————————- –>
<META HTTP-EQUIV=”Content-type” CONTENT=”text/html; charset=UTF-8″>
<!– ———————————————————————- –>
<!– NOTE: Please add the following <FORM> element to your page. –>
<!– ———————————————————————- –>
<form action=”https://webto.salesforce.com/servlet/servlet.WebToLead?encoding=UTF-8&orgId=00D6g00000537Pm” method=”POST”>
<input type=hidden name=”oid” value=”00D6g00000537Pm”>
<input type=hidden name=”retURL” value=”http://”>
<!– ———————————————————————- –>
<!– NOTE: These fields are optional debugging elements. Please uncomment –>
<!– these lines if you wish to test in debug mode. –>
<!– <input type=”hidden” name=”debug” value=1> –>
<!– <input type=”hidden” name=”debugEmail” –>
<!– value=”
lo*******@po******************.com
“> –>
<!– ———————————————————————- –>
<label for=”first_name”>First Name</label><input id=”first_name” maxlength=”40″ name=”first_name” size=”20″ type=”text” /><br>
<label for=”last_name”>Last Name</label><input id=”last_name” maxlength=”80″ name=”last_name” size=”20″ type=”text” /><br>
<label for=”email”>Email</label><input id=”email” maxlength=”80″ name=”email” size=”20″ type=”text” /><br>
<label for=”company”>Company</label><input id=”company” maxlength=”40″ name=”company” size=”20″ type=”text” /><br>
<label for=”city”>City</label><input id=”city” maxlength=”40″ name=”city” size=”20″ type=”text” /><br>
<label for=”state”>State/Province</label><input id=”state” maxlength=”20″ name=”state” size=”20″ type=”text” /><br>
Total Insured Value:<input id=”00N6g00000VfaZE” name=”00N6g00000VfaZE” size=”20″ type=”text” /><br>
<input type=”submit” name=”submit”>
</form>
