<!-- Note :<!-- [et_pb_line_break_holder] --> - You can modify the font style and form style to suit your website.<!-- [et_pb_line_break_holder] --> - 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.<!-- [et_pb_line_break_holder] --> - The Mandatory check script can modified as to suit your business needs.<!-- [et_pb_line_break_holder] --> - It is important that you test the modified form before going live.--><!-- [et_pb_line_break_holder] --><div id='crmWebToEntityForm' style='width:100%;'><!-- [et_pb_line_break_holder] --> <META HTTP-EQUIV ='content-type' CONTENT='text/html;charset=UTF-8'><!-- [et_pb_line_break_holder] --> <form action='https://crm.zoho.com/crm/WebToLeadForm' name=WebToLeads3073232000000170031 method='POST' onSubmit='javascript:document.charset="UTF-8"; return checkMandatory()' accept-charset='UTF-8' ><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><!-- Do not remove this code. --><!-- [et_pb_line_break_holder] --><input type='text' style='display:none;' name='xnQsjsdp' value='08cb31a15c6ad55784de9729af29e3da37460b33f174c7847927abdc602f0d34'/><!-- [et_pb_line_break_holder] --><input type='hidden' name='zc_gad' id='zc_gad' value=''/><!-- [et_pb_line_break_holder] --><input type='text' style='display:none;' name='xmIwtLD' value='eb5ba1a8e3e633286e22383e3afa623430eea7cef5e380ad99cbbfb5ed403809'/><!-- [et_pb_line_break_holder] --><input type='text' style='display:none;' name='actionType' value='TGVhZHM='/><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><input type='text' style='display:none;' name='returnURL' value='https://ozgrindpolishedconcrete.com.au/thank-you/' /><!-- [et_pb_line_break_holder] --><!-- Do not remove this code. --><!-- [et_pb_line_break_holder] --><input type='text' style='display:none;' id='ldeskuid' name='ldeskuid'></input><!-- [et_pb_line_break_holder] --><input type='text' style='display:none;' id='LDTuvid' name='LDTuvid'></input><!-- [et_pb_line_break_holder] --><!-- Do not remove this code. --><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><div style='display:none;' ><!-- [et_pb_line_break_holder] --><select style='width:250px;' name='Lead Source'><!-- [et_pb_line_break_holder] --><option value='-None-'>-None-</option><!-- [et_pb_line_break_holder] --><option value='Referral'>Referral</option><!-- [et_pb_line_break_holder] --><option value='Architect'>Architect</option><!-- [et_pb_line_break_holder] --><option value='Builder'>Builder</option><!-- [et_pb_line_break_holder] --><option value='Van on Site'>Van on Site</option><!-- [et_pb_line_break_holder] --><option value='AIA Session'>AIA Session</option><!-- [et_pb_line_break_holder] --><option value='Word of Mouth'>Word of Mouth</option><!-- [et_pb_line_break_holder] --><option value='Google AdWords'>Google AdWords</option><!-- [et_pb_line_break_holder] --><option selected value='Website'>Website</option><!-- [et_pb_line_break_holder] --><option value='Chat'>Chat</option><!-- [et_pb_line_break_holder] --><option value='Facebook'>Facebook</option><!-- [et_pb_line_break_holder] --><option value='Instagram'>Instagram</option><!-- [et_pb_line_break_holder] --><option value='Twitter'>Twitter</option><!-- [et_pb_line_break_holder] --><option value='LinkedIn'>LinkedIn</option><!-- [et_pb_line_break_holder] --><option value='YouTube'>YouTube</option><!-- [et_pb_line_break_holder] --><option value='Google+'>Google+</option><!-- [et_pb_line_break_holder] --><option value='Spotify'>Spotify</option><!-- [et_pb_line_break_holder] --><option value='Gumtree'>Gumtree</option><!-- [et_pb_line_break_holder] --><option value='Email'>Email</option><!-- [et_pb_line_break_holder] --><option value='Trade Show'>Trade Show</option><!-- [et_pb_line_break_holder] --><option value='Networking Event'>Networking Event</option><!-- [et_pb_line_break_holder] --><option value='Social Event'>Social Event</option><!-- [et_pb_line_break_holder] --><option value='Outbound Phone'>Outbound Phone</option><!-- [et_pb_line_break_holder] --><option value='Onsite Introduction'>Onsite Introduction</option><!-- [et_pb_line_break_holder] --><option value='TV'>TV</option><!-- [et_pb_line_break_holder] --><option value='Radio'>Radio</option><!-- [et_pb_line_break_holder] --><option value='Print'>Print</option><!-- [et_pb_line_break_holder] --><option value='Not Sure'>Not Sure</option><!-- [et_pb_line_break_holder] --><option value='Other'>Other</option><!-- [et_pb_line_break_holder] --></select></div><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><div style='display:none;' ><!-- [et_pb_line_break_holder] --><select style='width:250px;' name='Lead Status'><!-- [et_pb_line_break_holder] --><option value='-None-'>-None-</option><!-- [et_pb_line_break_holder] --><option selected value='Not Yet Contacted'>Not Yet Contacted</option><!-- [et_pb_line_break_holder] --><option value='Unable To Contact'>Unable To Contact</option><!-- [et_pb_line_break_holder] --><option value='Wants A Site Visit'>Wants A Site Visit</option><!-- [et_pb_line_break_holder] --><option value='Has Had A Site Visit'>Has Had A Site Visit</option><!-- [et_pb_line_break_holder] --><option value='Has Had A Showroom Visit'>Has Had A Showroom Visit</option><!-- [et_pb_line_break_holder] --><option value='Email Bounced'>Email Bounced</option><!-- [et_pb_line_break_holder] --><option value='Job Is On Hold'>Job Is On Hold</option><!-- [et_pb_line_break_holder] --><option value='No Longer Interested'>No Longer Interested</option><!-- [et_pb_line_break_holder] --><option value='Junk Lead'>Junk Lead</option><!-- [et_pb_line_break_holder] --><option value='Job Not Wanted By Us'>Job Not Wanted By Us</option><!-- [et_pb_line_break_holder] --></select></div><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p><!-- [et_pb_line_break_holder] --><div class='one_half'><!-- [et_pb_line_break_holder] --><span class="wpcf7-form-control-wrap your-name"><!-- [et_pb_line_break_holder] --><input type="text" name="First Name" value="" size="40" class="wpcf7-form-control wpcf7-text wpcf7-validates-as-required" aria-required="true" aria-invalid="false" placeholder="First Name" /></span><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --><div class='one_half et_column_last'><!-- [et_pb_line_break_holder] --><input type="text" name="Last Name" value="" size="40" class="wpcf7-form-control wpcf7-text wpcf7-validates-as-required" aria-required="true" aria-invalid="false" placeholder="Last Name" /></span><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --><div class='clear'></div></p><!-- [et_pb_line_break_holder] --><p><div class='one_half'><!-- [et_pb_line_break_holder] --><span class="wpcf7-form-control-wrap your-email"><input type="email" name="Email" value="" size="40" class="wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-required wpcf7-validates-as-email" aria-required="true" aria-invalid="false" placeholder="Email" /></span><!-- [et_pb_line_break_holder] --></div><div class='one_half et_column_last'><!-- [et_pb_line_break_holder] --><span class="wpcf7-form-control-wrap phone"><input type="tel" name="Phone" value="" size="40" class="wpcf7-form-control wpcf7-text wpcf7-tel wpcf7-validates-as-required wpcf7-validates-as-tel" aria-required="true" aria-invalid="false" placeholder="Phone" /></span><!-- [et_pb_line_break_holder] --></div><div class='clear'></div><br /><!-- [et_pb_line_break_holder] --><div class='one_half'><!-- [et_pb_line_break_holder] --><span class="wpcf7-form-control-wrap postcode"><input type="text" name="Zip Code" value="" size="40" class="wpcf7-form-control wpcf7-text wpcf7-validates-as-required" aria-required="true" aria-invalid="false" placeholder="Post Code" /></span><!-- [et_pb_line_break_holder] --></div><div class='one_half et_column_last'><!-- [et_pb_line_break_holder] --><span class="wpcf7-form-control-wrap neworold"><!-- [et_pb_line_break_holder] --><select style="padding:15px !important;" name='LEADCF13' class="wpcf7-form-control wpcf7-text wpcf7-validates-as-required" aria-required="true" aria-invalid="false"><!-- [et_pb_line_break_holder] --><option value='-None-'>Is your concrete recently poured or old/existing?</option><!-- [et_pb_line_break_holder] --><option value='New/Recently Poured Concrete'>New/Recently Poured Concrete</option><!-- [et_pb_line_break_holder] --><option value='Old/Existing Concrete'>Old/Existing Concrete</option><!-- [et_pb_line_break_holder] --><option value='Other'>Other</option><!-- [et_pb_line_break_holder] --></select><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --></span><!-- [et_pb_line_break_holder] --></div><div class='clear'></div><br /><!-- [et_pb_line_break_holder] --><div class='one_half'><!-- [et_pb_line_break_holder] --><span class="wpcf7-form-control-wrap floorsize"><!-- [et_pb_line_break_holder] --><input type="text" name="LEADCF11" value="" size="40" class="wpcf7-form-control wpcf7-text wpcf7-validates-as-required" aria-required="true" aria-invalid="false" placeholder="Approximate floor size (in square meters)" /></span><!-- [et_pb_line_break_holder] --></div><div class='one_half et_column_last'><!-- [et_pb_line_break_holder] --><span class="wpcf7-form-control-wrap insideoroutside"><!-- [et_pb_line_break_holder] --><select style="padding:15px !important;" name='LEADCF12' class="wpcf7-form-control wpcf7-text wpcf7-validates-as-required" aria-required="true" aria-invalid="false"><!-- [et_pb_line_break_holder] --><option value='-None-'>Is your concrete inside or outside?</option><!-- [et_pb_line_break_holder] --><option value='Inside'>Inside</option><!-- [et_pb_line_break_holder] --><option value='Outside'>Outside</option><!-- [et_pb_line_break_holder] --><option value='Inside & Outside'>Inside & Outside</option><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --></select><!-- [et_pb_line_break_holder] --></span><!-- [et_pb_line_break_holder] --></div><div class='clear'></div><br /><!-- [et_pb_line_break_holder] --><div class='one_half'><!-- [et_pb_line_break_holder] --><span class="wpcf7-form-control-wrap message"><textarea name="LEADCF10" cols="40" rows="10" class="wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required" aria-required="true" aria-invalid="false" placeholder="Message"></textarea></span><!-- [et_pb_line_break_holder] --></div><div class='one_half et_column_last'><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <tr><td></td><!-- [et_pb_line_break_holder] --> <!-- Do not remove this code. --><!-- [et_pb_line_break_holder] --> <td><img id='imgid' src='https://crm.zoho.com/crm/CaptchaServlet?formId=eb5ba1a8e3e633286e22383e3afa623430eea7cef5e380ad99cbbfb5ed403809&grpid=08cb31a15c6ad55784de9729af29e3da37460b33f174c7847927abdc602f0d34'><!-- [et_pb_line_break_holder] --> <a href='javascript:;' onclick='reloadImg()'>Refresh</a></td><!-- [et_pb_line_break_holder] --> </tr><br><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <tr><td><input type='text' class="wpcf7-form-control wpcf7-text" placeholder="Enter the Captcha Code Above" style='width:250px;' maxlength='80' name='enterdigest' /></td><!-- [et_pb_line_break_holder] --> </tr><br><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --><input type="submit" value="Send" class="wpcf7-form-control wpcf7-submit" /><!-- [et_pb_line_break_holder] --></div><div class='clear'></div></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><script><!-- [et_pb_line_break_holder] --> /* Do not remove this code. */<!-- [et_pb_line_break_holder] --> function reloadImg() {<!-- [et_pb_line_break_holder] --> if(document.getElementById('imgid').src.indexOf('&d') !== -1 ) {<!-- [et_pb_line_break_holder] --> document.getElementById('imgid').src=document.getElementById('imgid').src.substring(0,document.getElementById('imgid').src.indexOf('&d'))+'&d'+new Date().getTime();<!-- [et_pb_line_break_holder] --> } else {<!-- [et_pb_line_break_holder] --> document.getElementById('imgid').src = document.getElementById('imgid').src+'&d'+new Date().getTime();<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --></script><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><script><!-- [et_pb_line_break_holder] --> var mndFileds=new Array('Zip Code','First Name','Last Name','Phone','Email','LEADCF10','LEADCF13','LEADCF12','LEADCF11');<!-- [et_pb_line_break_holder] --> var fldLangVal=new Array('Post Code','First Name','Last Name','Phone Number','Email','Message','Is your concrete recently poured or old/existing?','Is your concrete inside or outside?','Approximate floor size (in square meters)');<!-- [et_pb_line_break_holder] -->var name='';<!-- [et_pb_line_break_holder] -->var email='';<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> function checkMandatory() {<!-- [et_pb_line_break_holder] -->for(i=0;i<mndFileds.length;i++) {<!-- [et_pb_line_break_holder] --> var fieldObj=document.forms['WebToLeads3073232000000170031'][mndFileds[i]];<!-- [et_pb_line_break_holder] --> if(fieldObj) {<!-- [et_pb_line_break_holder] -->if (((fieldObj.value).replace(/^\s+|\s+$/g, '')).length==0) {<!-- [et_pb_line_break_holder] -->if(fieldObj.type =='file')<!-- [et_pb_line_break_holder] -->{<!-- [et_pb_line_break_holder] -->alert('Please select a file to upload.');<!-- [et_pb_line_break_holder] -->fieldObj.focus();<!-- [et_pb_line_break_holder] -->return false;<!-- [et_pb_line_break_holder] -->}<!-- [et_pb_line_break_holder] -->alert(fldLangVal[i] +' cannot be empty');<!-- [et_pb_line_break_holder] --> fieldObj.focus();<!-- [et_pb_line_break_holder] --> return false;<!-- [et_pb_line_break_holder] -->} else if(fieldObj.nodeName=='SELECT') {<!-- [et_pb_line_break_holder] --> if(fieldObj.options[fieldObj.selectedIndex].value=='-None-') {<!-- [et_pb_line_break_holder] -->alert(fldLangVal[i] +' cannot be none');<!-- [et_pb_line_break_holder] -->fieldObj.focus();<!-- [et_pb_line_break_holder] -->return false;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] -->} else if(fieldObj.type =='checkbox'){<!-- [et_pb_line_break_holder] -->if(fieldObj.checked == false){<!-- [et_pb_line_break_holder] -->alert('Please accept '+fldLangVal[i]);<!-- [et_pb_line_break_holder] -->fieldObj.focus();<!-- [et_pb_line_break_holder] -->return false;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] -->}<!-- [et_pb_line_break_holder] -->try {<!-- [et_pb_line_break_holder] --> if(fieldObj.name == 'Last Name') {<!-- [et_pb_line_break_holder] -->name = fieldObj.value;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] -->} catch (e) {}<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] -->}<!-- [et_pb_line_break_holder] -->trackVisitor();<!-- [et_pb_line_break_holder] -->}<!-- [et_pb_line_break_holder] --></script><script type='text/javascript' id='VisitorTracking'>var $zoho= $zoho || {};$zoho.salesiq = $zoho.salesiq || {widgetcode:'1843108d6ac4fe6ead9b824790655a55617799c6165e9a3995df3f19cce93b79', values:{},ready:function(){$zoho.salesiq.floatbutton.visible('hide');}};var d=document;s=d.createElement('script');s.type='text/javascript';s.id='zsiqscript';s.defer=true;s.src='https://salesiq.zoho.com/widget';t=d.getElementsByTagName('script')[0];t.parentNode.insertBefore(s,t);function trackVisitor(){try{if($zoho){var LDTuvidObj = document.forms['WebToLeads3073232000000170031']['LDTuvid'];if(LDTuvidObj){LDTuvidObj.value = $zoho.salesiq.visitor.uniqueid();}var firstnameObj = document.forms['WebToLeads3073232000000170031']['First Name'];if(firstnameObj){name = firstnameObj.value +' '+name;}$zoho.salesiq.visitor.name(name);var emailObj = document.forms['WebToLeads3073232000000170031']['Email'];if(emailObj){email = emailObj.value;$zoho.salesiq.visitor.email(email);}}} catch(e){}}</script><!-- [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] --><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --></form><!-- [et_pb_line_break_holder] --></div>