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<html>
<head>
<script src="http://ajax.googleapis.com/ajax/libs/jquery/1.4.2/jquery.min.js"></script>
<script src="http://ajax.microsoft.com/ajax/jquery.validate/1.7/jquery.validate.min.js"></script>
<style type="text/css">
label { width: 15em; float: left; }
label.error { float: none; color: red; padding-left: .5em; vertical-align: top; }
</style>
</head>
<body>
<form id="roi-form" action="https://www.salesforce.com/servlet/servlet.WebToLead?encoding=UTF-8" method="POST"> <input name="oid" value="00D400000008pQT" type="hidden" /> <input name="retURL" value="http://c2logix.com/component/content/article/123" type="hidden" />
<p>
<label for="first_name">First Name: </label>
<input id="first_name" maxlength="40" name="first_name" size="20" type="text" class="required"/>
</p>
<p>
<label for="last_name">Last Name: </label>
<input id="last_name" maxlength="80" name="last_name" size="20" type="text" class="required"/>
</p>
<p>
<label for="phone">Phone</label>
<input id="phone" maxlength="40" name="phone" size="20" type="text" class="required"/>
</p>
<p>
<label for="email">Email</label>
<input id="email" maxlength="40" name="email" size="20" type="text" class="required"/>
</p>
<p>
<label for="company">Company</label>
<input id="company" maxlength="40" name="company" size="20" type="text" />
</p>
<p>
<label for="city">City</label>
<input id="city" maxlength="40" name="city" size="20" type="text" />
</p>
<p>
<label for="state">State/Province</label>
<input id="state" maxlength="20" name="state" size="20" type="text" />
</p>
<p>
<label for="00N40000001i3Xw">Products interested in:</label>
<select id="00N40000001i3Xw" name="00N40000001i3Xw" title="Products interested in"> <option value="C2RouteApp">C2RouteApp</option> <option value="C2RouteApp-API">C2RouteApp-API</option> <option value="FleetRoute">FleetRoute</option> <option value="TourSolver">TourSolver</option> <option value="Routing Service Bureau">Routing Service Bureau</option> <option value="Route Optimization Consultation Service">Route Optimization Consultation Service</option> <option value="Custom Application Development">Custom Application Development</option> <option value="C2RouteApp Demo">C2RouteApp Demo</option> <option value="FleetRoute Demo">FleetRoute Demo</option> <option value="TourSolver Demo">TourSolver Demo</option> <option value="Street Data">Street Data</option> <option value="Not sure which Product I need">Not sure which Product I need</option> <option value="Newsletter Opt-in">Newsletter Opt-in</option> </select>
</p>
<p>
<label for="00N400000028tUt">Number or Vehicles or Routes:</label>
<input id="00N400000028tUt" name="00N400000028tUt" size="20" type="text" />
</p>
<p>
<label for="00N400000028tV3">Total Stops or Locations:</label>
<input id="00N400000028tV3" name="00N400000028tV3" size="20" type="text" />
</p>
<p>
<label for="00N40000001h9AL">Questions or Comments:</label>
<input id="00N40000001h9AL" maxlength="255" name="00N40000001h9AL" size="20" type="text" />
</p>
<p>
<input name="submit" type="submit" id="submit"/>
</p>
</form>
<script type="text/javascript">
jQuery.noConflict();
jQuery(function() {
jQuery("#roi-form").validate();
});
</script>
</body>