[text* domainname class:textfield1 watermark “Domain Name”] | [text* company class:textfield1 watermark “Company”] |
[text* firstname class:textfield1 watermark “First Name”] | [text* lastname class:textfield1 watermark “Last Name”] |
[text* email class:textfield1 watermark “Email”] | [text phone class:textfield1 watermark “Phone”] |
[checkbox* checkbox-196 “My customers are within 50 miles”] | |
[submit id:Submit class:submitbutton “Submit”] |