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This page would include a custom form to obtain personal information about your customers. This page would be highly tailored to your company's questions that it might ask of its prospective clients.
The results would in turn be emailed to a special email address that we set up for you (ie:responseform@yourcompany.com)

Sample Form

Name:

Address:

City: State: Zip:

Email:

Phone#

What services/products are you interested in (check all that apply)

Service 1
Service 2
Product 1

What servicesproducts are you interested in (check one)

Commercial
Residential
Non-Profit Organization

Choose a category of interest:

Leave a few comments for us:

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For information contact:
you@yourcompany.com