<style type="text/css"><!--<!-- [et_pb_line_break_holder] -->form#WebToLeadForm, form#WebToLeadForm * {margin: 0; padding: 0; border: none; color: #333; font-size: 12px; line-height: 1.6em; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif;}<!-- [et_pb_line_break_holder] -->form#WebToLeadForm {float: left; border: 1px solid #ccc; margin: 10px;}<!-- [et_pb_line_break_holder] -->form#WebToLeadForm h1 {font-size: 32px; font-weight: bold; background-color: rgb(60, 141, 188); color: rgb(247, 247, 247); padding: 10px 20px;}<!-- [et_pb_line_break_holder] -->form#WebToLeadForm h2 {font-size: 24px; font-weight: bold; background-color: rgb(60, 141, 188); color: rgb(247, 247, 247); padding: 10px 20px;}<!-- [et_pb_line_break_holder] -->form#WebToLeadForm h3 {font-size: 12px; font-weight: bold; padding: 10px 20px;}<!-- [et_pb_line_break_holder] -->form#WebToLeadForm h4 {font-size: 10px; font-weight: bold; padding: 10px 20px;}<!-- [et_pb_line_break_holder] -->form#WebToLeadForm h5 {font-size: 8px; font-weight: bold; padding: 10px 20px;}<!-- [et_pb_line_break_holder] -->form#WebToLeadForm h6 {font-size: 6px; font-weight: bold; padding: 10px 20px;}<!-- [et_pb_line_break_holder] -->form#WebToLeadForm p {padding: 10px 20px;}<!-- [et_pb_line_break_holder] -->form#WebToLeadForm input,<!-- [et_pb_line_break_holder] -->form#WebToLeadForm select,<!-- [et_pb_line_break_holder] -->form#WebToLeadForm textarea {border: 1px solid #ccc; display: block; float: left; min-width: 170px; padding: 5px;}<!-- [et_pb_line_break_holder] -->form#WebToLeadForm select {background-color: white;}<!-- [et_pb_line_break_holder] -->form#WebToLeadForm input[type="button"],<!-- [et_pb_line_break_holder] -->form#WebToLeadForm input[type="submit"] {display: inline; float: none; padding: 5px 10px; width: auto; min-width: auto;}<!-- [et_pb_line_break_holder] -->form#WebToLeadForm input[type="checkbox"],<!-- [et_pb_line_break_holder] -->form#WebToLeadForm input[type="radio"] {width: 18px; min-width: auto;}<!-- [et_pb_line_break_holder] -->form#WebToLeadForm div.col {display: block; float: left; width: 330px; padding: 10px 20px;}<!-- [et_pb_line_break_holder] -->form#WebToLeadForm div.clear {display: block; float: none; clear: both; height: 0px; overflow: hidden;}<!-- [et_pb_line_break_holder] -->form#WebToLeadForm div.center {text-align: center;}<!-- [et_pb_line_break_holder] -->form#WebToLeadForm div.buttons {padding: 10px 0; border-top: 1px solid #ccc; background-color: #f7f7f7}<!-- [et_pb_line_break_holder] -->form#WebToLeadForm label {display: block; float: left; width: 160px; font-weight: bold;}<!-- [et_pb_line_break_holder] -->form#WebToLeadForm span.required {color: #FF0000;}<!-- [et_pb_line_break_holder] -->--></style><!-- [et_pb_line_break_holder] --><!-- TODO ???<!-- [et_pb_line_break_holder] --><script type="text/javascript" src='https://crm.advertify.ca/cache/include/javascript/sugar_grp1.js?v=3ua22gm1sEaDqmAI4jPDTQ'></script><!-- [et_pb_line_break_holder] -->--><form id="WebToLeadForm" action="https://crm.advertify.ca/index.php?entryPoint=WebToPersonCapture" method="POST" name="WebToLeadForm"><!-- [et_pb_line_break_holder] --><h2>Contact the Advertify Team</h2><!-- [et_pb_line_break_holder] --><p>Submitting this form will provide your details to one of our team members who will contact you to follow up.</p><!-- [et_pb_line_break_holder] --><div class="row"><!-- [et_pb_line_break_holder] --><div class="col"><label>First Name: </label><input name="first_name" id="first_name" type="text" /></div><!-- [et_pb_line_break_holder] --><div class="col"><label>Last Name: <span class="required">*</span></label><input name="last_name" id="last_name" type="text" required="" /></div><!-- [et_pb_line_break_holder] --><div class="clear"> </div><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --><div class="row"><!-- [et_pb_line_break_holder] --><div class="col"><label>Office Phone: </label><input name="phone_work" id="phone_work" type="text" /></div><!-- [et_pb_line_break_holder] --><div class="col"><label>Email Address: </label><input name="email1" id="email1" type="email" /></div><!-- [et_pb_line_break_holder] --><div class="clear"> </div><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --><div class="row center buttons"><input class="button" name="Submit" type="submit" value="Submit" onclick="submit_form();" /><!-- [et_pb_line_break_holder] --><div class="clear"> </div><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --><input name="campaign_id" id="campaign_id" type="hidden" value="afd9dfa1-ebd5-11d4-91d2-5a6f1d30739e" /> <input name="redirect_url" id="redirect_url" type="hidden" value="https://goo.gl/nPbyKc" /> <input name="assigned_user_id" id="assigned_user_id" type="hidden" value="c0d6c0cf-0f6f-c90c-14f4-5a357c6cdef8" /> <input name="moduleDir" id="moduleDir" type="hidden" value="Leads" /></form><!-- [et_pb_line_break_holder] --><p><!-- [et_pb_line_break_holder] --><script type="text/javascript">// <![CDATA[<!-- [et_pb_line_break_holder] --> function submit_form() {<!-- [et_pb_line_break_holder] --> if (typeof(validateCaptchaAndSubmit) != 'undefined') {<!-- [et_pb_line_break_holder] --> validateCaptchaAndSubmit();<!-- [et_pb_line_break_holder] --> } else {<!-- [et_pb_line_break_holder] --> check_webtolead_fields();<!-- [et_pb_line_break_holder] --> //document.WebToLeadForm.submit();<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> function check_webtolead_fields() {<!-- [et_pb_line_break_holder] --> if (document.getElementById('bool_id') != null) {<!-- [et_pb_line_break_holder] --> var reqs = document.getElementById('bool_id').value;<!-- [et_pb_line_break_holder] --> bools = reqs.substring(0, reqs.lastIndexOf(';'));<!-- [et_pb_line_break_holder] --> var bool_fields = new Array();<!-- [et_pb_line_break_holder] --> var bool_fields = bools.split(';');<!-- [et_pb_line_break_holder] --> nbr_fields = bool_fields.length;<!-- [et_pb_line_break_holder] --> for (var i = 0; i < nbr_fields; i++) {<!-- [et_pb_line_break_holder] --> if (document.getElementById(bool_fields[i]).value == 'on') {<!-- [et_pb_line_break_holder] --> document.getElementById(bool_fields[i]).value = 1;<!-- [et_pb_line_break_holder] --> } else {<!-- [et_pb_line_break_holder] --> document.getElementById(bool_fields[i]).value = 0;<!-- [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] --></p>