Test Form
<!-- 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' class='zcwf_lblLeft crmWebToEntityForm' style='background-color: white;color: black;max-width: 600px;'>
<meta name='viewport' content='width=device-width, initial-scale=1.0'>
<META HTTP-EQUIV ='content-type' CONTENT='text/html;charset=UTF-8'>
<script src='https://www.google.com/recaptcha/api.js' async defer></script>
<form action='https://crm.zoho.com/crm/WebToContactForm' name=WebToContacts5286269000003029001 method='POST' onSubmit='javascript:document.charset="UTF-8"; return checkMandatory5286269000003029001()' accept-charset='UTF-8'>
<input type='text' style='display:none;' name='xnQsjsdp' value='74fe4163ef4aa896affa234feb51e517678e232441282802638f6c68f1dee4b8'></input>
<input type='hidden' name='zc_gad' id='zc_gad' value=''></input>
<input type='text' style='display:none;' name='xmIwtLD' value='41ca6965eeaa421e6e9494539a8de4d628cf2815b5c7b3bc75a16b94e7f47aa6'></input>
<input type='text' style='display:none;' name='actionType' value='Q29udGFjdHM='></input>
<input type='text' style='display:none;' name='returnURL' value='https://www.harmonie.mu/en/contact-us/confirmation' > </input>
<!-- Do not remove this code. -->
<input type='text' style='display:none;' id='ldeskuid' name='ldeskuid'></input>
<input type='text' style='display:none;' id='LDTuvid' name='LDTuvid'></input>
<!-- Do not remove this code. -->
<style>
html,body{
margin: 0px;
}
label{
display: none !important;
}
select {
background: #ecf0f1;
}
::placeholder, {
/* Chrome, Firefox, Opera, Safari 10.1+ */
color: rgb(53, 51, 51);
opacity: 1;
/* Firefox */
}
.line {
Display:flex;
}
input,textarea {
background: #ECF0F1;
}
#crmWebToEntityForm.zcwf_lblLeft {
width:100%;
padding: 25px;
margin: 0 auto;
box-sizing: border-box;
}
#crmWebToEntityForm.zcwf_lblLeft * {
box-sizing: border-box;
}
#crmWebToEntityForm{text-align: left;}
#crmWebToEntityForm * {
direction: ltr;
}
.zcwf_lblLeft .zcwf_title {
word-wrap: break-word;
padding: 0px 6px 10px;
font-weight: bold;
}
.zcwf_lblLeft .zcwf_col_fld input[type=text], .zcwf_lblLeft .zcwf_col_fld textarea {
width: 60%;
border: 1px solid #ccc !important;
resize: vertical;
border-radius: 2px;
float: left;
}
.zcwf_lblLeft .zcwf_col_lab {
width: 30%;
word-break: break-word;
padding: 0px 6px 0px;
margin-right: 10px;
margin-top: 5px;
float: left;
min-height: 1px;
}
.zcwf_lblLeft .zcwf_col_fld {
float: left;
width: 100%;
padding: 0px 6px 0px;
position: relative;
margin-top: 5px;
}
.zcwf_lblLeft .zcwf_privacy{padding: 6px;}
.zcwf_lblLeft .wfrm_fld_dpNn{display: none;}
.dIB{display: inline-block;}
.zcwf_lblLeft .zcwf_col_fld_slt {
width: 100%;
border: 1px solid #ccc;
background: #fff;
border-radius: 4px;
font-size: 12px;
float: left;
resize: vertical;
padding: 2px 5px;
}
.zcwf_lblLeft .zcwf_row:after, .zcwf_lblLeft .zcwf_col_fld:after {
content: '';
display: table;
clear: both;
}
.zcwf_lblLeft .zcwf_col_help {
float: left;
margin-left: 7px;
font-size: 12px;
max-width: 35%;
word-break: break-word;
}
.zcwf_lblLeft .zcwf_help_icon {
cursor: pointer;
width: 16px;
height: 16px;
display: inline-block;
background: #fff;
border: 1px solid #ccc;
color: #ccc;
text-align: center;
font-size: 11px;
line-height: 16px;
font-weight: bold;
border-radius: 50%;
}
.zcwf_lblLeft .zcwf_row {margin: 2px 0px;}
.zcwf_lblLeft .formsubmit {
margin-right: 5px;
cursor: pointer;
color: #333;
font-size: 12px;
}
.zcwf_lblLeft .zcwf_privacy_txt {
width: 90%;
color: rgb(0, 0, 0);
font-size: 12px;
font-family: Arial;
display: inline-block;
vertical-align: top;
color: #333;
padding-top: 2px;
margin-left: 6px;
}
.zcwf_lblLeft .zcwf_button {
font-size: 12px;
color: #333;
border: 1px solid #ccc;
padding: 3px 9px;
border-radius: 4px;
cursor: pointer;
overflow: hidden;
text-overflow: ellipsis;
white-space: nowrap;
}
.zcwf_lblLeft .zcwf_tooltip_over{
position: relative;
}
.zcwf_lblLeft .zcwf_tooltip_ctn{
position: absolute;
background: #dedede;
padding: 3px 6px;
top: 3px;
border-radius: 4px;word-break: break-word;
min-width: 100px;
max-width: 150px;
color: #333;
z-index: 100;
}
.zcwf_lblLeft .zcwf_ckbox{
float: left;
}
.zcwf_lblLeft .zcwf_file{
width: 55%;
box-sizing: border-box;
float: left;
}
.clearB:after{
content:'';
display: block;
clear: both;
}
@media all and (max-width: 600px) {
.zcwf_lblLeft .zcwf_col_lab, .zcwf_lblLeft .zcwf_col_fld {
width: auto;
float: none !important;
}
.zcwf_lblLeft .zcwf_col_help {width: 40%;}
}
</style>
<div class='zcwf_title' style='max-width: 600px;color: black;'>Web to Contact</div>
<div class="line">
<div class='zcwf_row' style="width:50%;" ><div class='zcwf_col_lab' style='font-size:12px; font-family: Arial;'><label for='First_Name'>First Name<span style='color:red;'>*</span></label></div><div class='zcwf_col_fld'><input style="width: 100%;" placeholder="First Name" type='text' id='First_Name' name='First Name' maxlength='40'></input><div class='zcwf_col_help'></div></div></div>
<div class='zcwf_row'style="width:50%;" ><div class='zcwf_col_lab' style='font-size:12px; font-family: Arial;'><label for='Last_Name'>Last Name<span style='color:red;'>*</span></label></div><div class='zcwf_col_fld'><input style="width: 100%;" type='text' placeholder="Last Name" id='Last_Name' name='Last Name' maxlength='100'></input><div class='zcwf_col_help'></div></div></div>
</div>
<div class="line">
<div class='zcwf_row' style="width:100%;" ><div class='zcwf_col_lab' style='font-size:12px; font-family: Arial;'><label for='Email'>Email<span style='color:red;'>*</span></label></div><div class='zcwf_col_fld'><input placeholder="Email" style="width:100%;"type='text' ftype='email' id='Email' name='Email' maxlength='100'></input><div class='zcwf_col_help'></div></div></div>
</div>
<div class='zcwf_row'><div class='zcwf_col_lab' style='font-size:12px; font-family: Arial;'><label for='CONTACTCF104'>Marketing Consent<span style='color:red;'>*</span></label></div><div class='zcwf_col_fld'>
<div style="display: flex;">
<div>
<input type='checkbox' class='zcwf_ckbox' id='CONTACTCF104' name='CONTACTCF104' maxlength='3'></input>
</div>
<div style="padding-left:6px;">
<span style="font-size: 11px;">I give consent to be contacted by telephone, e-mail or mail to receive more information about our products and services. I am aware that I have the right to withdraw my consent at any time, by sending an e-mail to info@harmonie.mu. Please check our <a href="https://www.harmonie.mu/en/privacy-policy" target="_blank">privacy policy</a> for details
</span>
</div>
</div>
<div class="line">
<div class='zcwf_row' style="width:60%;" > <div class='zcwf_col_lab'></div><div class='zcwf_col_fld'><div class='g-recaptcha' data-sitekey='6LeyMrQiAAAAABfpMl2AhfDcQioKLRpUhIMHCbbq' data-theme='light' data-callback='rccallback5286269000003029001' captcha-verified='false' id='recap5286269000003029001'></div><div id='recapErr5286269000003029001' style='font-size:12px;color:red;visibility:hidden;'>Captcha validation failed. If you are not a robot then please try again.</div></div></div>
<div class='zcwf_row wfrm_fld_dpNn'><div class='zcwf_col_lab' style='font-size:12px; font-family: Arial;'><label for='CONTACTCF11'>Preferred Language</label></div><div class='zcwf_col_fld'><select class='zcwf_col_fld_slt' id='CONTACTCF11' name='CONTACTCF11' >
<option value='-None-'>-None-</option>
<option selected value='EN'>EN</option>
<option value='FR'>FR</option>
</select><div class='zcwf_col_help'></div></div></div>
<div class='zcwf_row wfrm_fld_dpNn'><div class='zcwf_col_lab' style='font-size:12px; font-family: Arial;'><label for='Lead_Source'>Lead Source</label></div><div class='zcwf_col_fld'><select class='zcwf_col_fld_slt' id='Lead_Source' name='Lead Source' >
<option value='-None-'>-None-</option>
<option selected value='LSPL'>LSPL</option>
<option value='Beachcomber'>Beachcomber</option>
<option value='Sales Agent'>Sales Agent</option>
<option value='External Referral'>External Referral</option>
</select><div class='zcwf_col_help'></div></div></div>
<div class='zcwf_row wfrm_fld_dpNn'><div class='zcwf_col_lab' style='font-size:12px; font-family: Arial;'><label for='CONTACTCF12'>Channel</label></div><div class='zcwf_col_fld'><select class='zcwf_col_fld_slt' id='CONTACTCF12' name='CONTACTCF12' >
<option value='-None-'>-None-</option>
<option value='Ads'>Ads</option>
<option value='Facebook'>Facebook</option>
<option value='Digital Advertising'>Digital Advertising</option>
<option value='Traditional Advertising'>Traditional Advertising</option>
<option value='Word of Mouth'>Word of Mouth</option>
<option value='Contact by phone'>Contact by phone</option>
<option value='Events'>Events</option>
<option value='Landing Page'>Landing Page</option>
<option selected value='Website'>Website</option>
<option value='Direct Email'>Direct Email</option>
<option value='Email Marketing'>Email Marketing</option>
<option value='Walk-in'>Walk-in</option>
<option value='Organic search'>Organic search</option>
<option value='Google'>Google</option>
</select><div class='zcwf_col_help'></div></div></div>
<div class='zcwf_row wfrm_fld_dpNn'><div class='zcwf_col_lab' style='font-size:12px; font-family: Arial;'><label for='CONTACTCF20'>Form ID</label></div><div class='zcwf_col_fld'><input type='text' id='CONTACTCF20' name='CONTACTCF20' maxlength='255' value='subscription'></input><div class='zcwf_col_help'></div></div></div>
<div class='zcwf_row' style="width:40%;"><div class='zcwf_col_lab'></div><div class='zcwf_col_fld'><input type='submit' id='formsubmit' class='formsubmit zcwf_button' value='Submit' style="width:100%;" title='Submit'><input type='reset' style="display:none" class='zcwf_button' name='reset' value='Reset' title='Reset'></div></div>
</div>
<script>
/* Do not remove this code. */
function rccallback5286269000003029001()
{
if(document.getElementById('recap5286269000003029001')!=undefined){
document.getElementById('recap5286269000003029001').setAttribute('captcha-verified',true);
}
if(document.getElementById('recapErr5286269000003029001')!=undefined && document.getElementById('recapErr5286269000003029001').style.visibility == 'visible' ){
document.getElementById('recapErr5286269000003029001').style.visibility='hidden';
}
}
function reCaptchaAlert5286269000003029001()
{
var recap = document.getElementById('recap5286269000003029001');
if( recap !=undefined && recap.getAttribute('captcha-verified') == 'false')
{
document.getElementById('recapErr5286269000003029001').style.visibility='visible';
return false;
}
return true;
}
function validateEmail5286269000003029001()
{
var form = document.forms['WebToContacts5286269000003029001'];
var emailFld = form.querySelectorAll('[ftype=email]');
var i;
for (i = 0; i < emailFld.length; i++)
{
var emailVal = emailFld[i].value;
if((emailVal.replace(/^\s+|\s+$/g, '')).length!=0 )
{
var atpos=emailVal.indexOf('@');
var dotpos=emailVal.lastIndexOf('.');
if (atpos<1 || dotpos<atpos+2 || dotpos+2>=emailVal.length)
{
alert('Please enter a valid email address. ');
emailFld[i].focus();
return false;
}
}
}
return true;
}
function checkMandatory5286269000003029001() {
var mndFileds = new Array('First Name','Last Name','Email','CONTACTCF104');
var fldLangVal = new Array('First\x20Name','Last\x20Name','Email','Marketing\x20Consent');
for(i=0;i<mndFileds.length;i++) {
var fieldObj=document.forms['WebToContacts5286269000003029001'][mndFileds[i]];
if(fieldObj) {
if (((fieldObj.value).replace(/^\s+|\s+$/g, '')).length==0) {
if(fieldObj.type =='file')
{
alert('Please select a file to upload.');
fieldObj.focus();
return false;
}
alert(fldLangVal[i] +' cannot be empty.');
fieldObj.focus();
return false;
} else if(fieldObj.nodeName=='SELECT') {
if(fieldObj.options[fieldObj.selectedIndex].value=='-None-') {
alert(fldLangVal[i] +' cannot be none.');
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) {}
}
}
trackVisitor5286269000003029001();
if(!validateEmail5286269000003029001()){return false;}
if(!reCaptchaAlert5286269000003029001()){return false;}
document.querySelector('.crmWebToEntityForm .formsubmit').setAttribute('disabled', true);
}
function tooltipShow5286269000003029001(el){
var tooltip = el.nextElementSibling;
var tooltipDisplay = tooltip.style.display;
if(tooltipDisplay == 'none'){
var allTooltip = document.getElementsByClassName('zcwf_tooltip_over');
for(i=0; i<allTooltip.length; i++){
allTooltip[i].style.display='none';
}
tooltip.style.display = 'block';
}else{
tooltip.style.display='none';
}
}
</script><script type='text/javascript' id='VisitorTracking'>var $zoho= $zoho || {salesiq:{values:{},ready:function(){}}};var d=document;s=d.createElement('script');s.type='text/javascript';s.defer=true;s.src='https://salesiq.zoho.com/semarispropertydevelopment/float.ls?embedname=semarispropertydevelopment';t=d.getElementsByTagName('script')[0];t.parentNode.insertBefore(s,t);function trackVisitor5286269000003029001(){try{if($zoho){var LDTuvidObj = document.forms['WebToContacts5286269000003029001']['LDTuvid'];if(LDTuvidObj){LDTuvidObj.value = $zoho.salesiq.visitor.uniqueid();}var firstnameObj = document.forms['WebToContacts5286269000003029001']['First Name'];if(firstnameObj){name = firstnameObj.value +' '+name;}$zoho.salesiq.visitor.name(name);var emailObj = document.forms['WebToContacts5286269000003029001']['Email'];if(emailObj){email = emailObj.value;$zoho.salesiq.visitor.email(email);}}} catch(e){}}</script>
<!-- Do not remove this --- Analytics Tracking code starts --><script id='wf_anal' src='https://crm.zohopublic.com/crm/WebFormAnalyticsServeServlet?rid=41ca6965eeaa421e6e9494539a8de4d628cf2815b5c7b3bc75a16b94e7f47aa6gid74fe4163ef4aa896affa234feb51e517678e232441282802638f6c68f1dee4b8gid5cf99212d7958dbcd176c761c6ce0a4d7e43e277bdc5d8b9c12010015418942cgid14f4ec16431e0686150daa43f3210513&tw=61690b96c1d0471b638f31426f38e68aa67fb7ed6da86f32dc10ad817fe55a0a'></script><!-- Do not remove this --- Analytics Tracking code ends. --></form>
</div>
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