<!-- 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.-->
<div id="crmWebToEntityForm" style="width: 600px; margin: auto;">

&nbsp;
<table style="width: 600px; background-color: white; color: black;">
<tbody>
<tr>
<td style="color: black; font-family: Arial; font-size: 14px; text-align: center;" colspan="2"><strong>Agende uma visita</strong></td>
</tr>
<tr>
<td style="nowrap: nowrap; text-align: left; font-size: 12px; font-family: Arial; width: 200px;">Nome<span style="color: red;">*</span></td>
<td style="width: 250px;"><input style="width: 250px;" maxlength="80" name="Last Name" type="text" /></td>
</tr>
<tr>
<td style="nowrap: nowrap; text-align: left; font-size: 12px; font-family: Arial; width: 200px;">E-mail</td>
<td style="width: 250px;"><input style="width: 250px;" maxlength="100" name="Email" type="text" /></td>
</tr>
<tr>
<td style="nowrap: nowrap; text-align: left; font-size: 12px; font-family: Arial; width: 200px;">Telefone</td>
<td style="width: 250px;"><input style="width: 250px;" maxlength="30" name="Phone" type="text" /></td>
</tr>
<tr>
<td style="nowrap: nowrap; text-align: left; font-size: 12px; font-family: Arial; width: 200px;">Nome e idade da criança</td>
<td><textarea style="width: 250;" maxlength="1000" name="Description">&nbsp;</textarea></td>
</tr>
<tr>
<td style="text-align: center; padding-top: 15px;" colspan="2"><input style="font-size: 12px; color: #131307;" type="submit" value="Submeter" />
<input style="font-size: 12px; color: #131307;" type="reset" value="Reiniciar" /></td>
</tr>
</tbody>
</table>
<script>// <![CDATA[
var mndFileds=new Array('Last Name');
 	  var fldLangVal=new Array('Nome');
		var name='';
		var email='';

 	  function checkMandatory() {
		for(i=0;i<mndFileds.length;i++) { var fieldObj=document.forms['WebToLeads1513294000000098006'][mndFileds[i]]; if(fieldObj) { if (((fieldObj.value).replace(/^\s+|\s+$/g, '')).length==0) { if(fieldObj.type =='file') { alert('Por favor, selecione um arquivo para fazer o upload'); fieldObj.focus(); return false; } alert(fldLangVal[i] +' não pode ficar em branco'); fieldObj.focus(); return false; } else if(fieldObj.nodeName=='SELECT') { if(fieldObj.options[fieldObj.selectedIndex].value=='-None-') { alert(fldLangVal[i] +' não pode ser vazio'); fieldObj.focus(); return false; } } else if(fieldObj.type =='checkbox'){ if(fieldObj.checked == false){ alert('Please accept '+fldLangVal[i]); fieldObj.focus(); return false; } } try { if(fieldObj.name == 'Last Name') { name = fieldObj.value; } } catch (e) {} } } }
// ]]></script>

</div>