Ready-to-use "Contact Us" extended form
This is an extension of our "Contact Us" form. Use it when you need to gather more detailed information about your visitor.
The form is protected from SPAM with a Captcha image.
There are two types of forms available - BasicCaptcha script and
ProCaptcha protecton service.
Compare BasicCaptcha vs. ProCaptcha.
See the form screenshot
(ProCaptcha is shown) and then click Back.
If you already have a ProCaptcha account,
please feel free to request assistance
over phone or by Windows Live Messenger.
An email support is available to both members and non-members.
How to use BasicCaptcha code
1. Copy and paste the code below into your webpage.
2. Change the email address your@email.com to your own email address.
3. Change the return address http://www.YourWebsiteAddress.com/ThankYouPage.htm to your website address.
4. You can also change the email subject - Contact Us Captcha Form.
<h2>Contact Us</h2>
<form action="http://www.SnapHost.com/captcha/send.aspx" id="ContactUsCaptchaWebForm" method="post" onsubmit="return ValidateForm(this);">
<input id="skip_WhereToSend" name="skip_WhereToSend" type="hidden" value="your@email.com" />
<input id="skip_SnapHostID" name="skip_SnapHostID" type="hidden" value="A8KQJS6XFFPJ" />
<input id="skip_WhereToReturn" name="skip_WhereToReturn" type="hidden" value="http://www.YourWebsiteAddress.com/ThankYouPage.htm" />
<input id="skip_Subject" name="skip_Subject" type="hidden" value="Contact Us Form" />
<input id="skip_ShowUsersIp" name="skip_ShowUsersIp" type="hidden" value="1" />
<input id="skip_SendCopyToUser" name="skip_SendCopyToUser" type="hidden" value="1" />
<script type="text/javascript">
function ValidateForm(frm) {
if (frm.FirstName.value == "") {alert('First name is required.');frm.FirstName.focus();return false;}
if (frm.LastName.value == "") {alert('Last name is required.');frm.LastName.focus();return false;}
if (frm.FromEmailAddress.value == "") {alert('Email address is required.');frm.FromEmailAddress.focus();return false;}
if (frm.FromEmailAddress.value.indexOf("@") < 1 || frm.FromEmailAddress.value.indexOf(".") < 1) {alert('Please enter a valid email address.');frm.FromEmailAddress.focus();return false;}
if (frm.Comments.value == "") {alert('Please enter comments or questions.');frm.Comments.focus();return false;}
if (frm.skip_CaptchaCode.value == "") {alert('Enter web form code.');frm.skip_CaptchaCode.focus();return false;}
return true; }
</script>
<table border="0" cellpadding="5" cellspacing="0" width="520">
<tr><td style="width:50%">First name*:<br />
<input id="FirstName" name="FirstName" type="text" maxlength="60" style="width:240px; border:1px solid #009900" /></td>
<td style="width:50%">Last name*:<br />
<input id="LastName" name="LastName" type="text" maxlength="60" style="width:240px; border:1px solid #009900" /></td>
</tr><tr>
<td>Email address*:<br />
<input id="FromEmailAddress" name="FromEmailAddress" type="text" maxlength="60" style="width:240px; border:1px solid #009900" /></td>
<td> </td>
</tr><tr>
<td>Work phone number:<br />
<input id="WorkPhoneNumber" name="WorkPhoneNumber" type="text" maxlength="60" style="width:240px; border:1px solid #009900" /></td>
<td>Fax number:<br />
<input id="FaxNumber" name="FaxNumber" type="text" maxlength="60" style="width:240px; border:1px solid #009900" /></td>
</tr><tr>
<td>Home phone number:<br />
<input id="HomePhoneNumber" name="HomePhoneNumber" type="text" maxlength="60" style="width:240px; border:1px solid #009900" /></td>
<td>Mobile phone number:<br />
<input id="MobilePhoneNumber" name="MobilePhoneNumber" type="text" maxlength="60" style="width:240px; border:1px solid #009900" /></td>
</tr><tr>
<td colspan="2">Address:<br />
<input id="Address" name="Address" type="text" maxlength="250" style="width:500px; border:1px solid #009900" /></td>
</tr><tr>
<td>City:<br />
<input id="City" name="City" type="text" maxlength="60" style="width:240px; border:1px solid #009900" /></td>
<td>State / Province / Region:<br />
<input id="State" name="State" type="text" maxlength="60" style="width:240px; border:1px solid #009900" /></td>
</tr><tr>
<td>Country:<br />
<input id="Country" name="Country" type="text" maxlength="60" style="width:240px; border:1px solid #009900" /></td>
<td>ZIP / Postal code:<br />
<input id="Zip" name="Zip" type="text" maxlength="60" style="width:240px; border:1px solid #009900" /></td>
</tr><tr>
<td colspan="2">Comments and questions*:<br />
<textarea name="Comments" id="Comments" rows="7" cols="40" style="width:500px; border:1px solid #009900"></textarea></td>
</tr><tr>
<td colspan="2" align="center"> <br />
<table border="0" cellpadding="0" cellspacing="0">
<tr><td colspan="2" style="padding-bottom:18px;">
<!-- Do not remove this link or we will block your website!
Please refer to our ProCaptcha service which is ad-free -->
<a href="http://www.SnapHost.com/captcha/ProCaptchaOverview.aspx"
style="text-decoration:none; font-size:11px; font-family:Verdana, Arial, Helvetica; color:#000099;">
This web form is protected from SPAM by
<span style="text-decoration:underline;">SnapHost.com</span></a></td></tr>
<tr valign="top"><td> <i>Enter web form code*:</i>
<input id="skip_CaptchaCode" name="skip_CaptchaCode" type="text" style="width:80px; border:1px solid #999999" maxlength="6" />
</td><td>
<a href="http://www.SnapHost.com/captcha/ProCaptchaOverview.aspx"><img alt="Web Form Code"
style="margin-left:20px; border:1px solid #999999"
src="http://www.SnapHost.com/captcha/CaptchaImage.aspx?id=A8KQJS6XFFPJ&ImgType=2" /></a>
</td></tr>
</table> <br />
* - required fields.
<input id="skip_Submit" name="skip_Submit" type="submit" value="Submit" />
</td></tr>
</table><br />
</form>
How to use ProCaptcha code
1. Copy and paste the code below into your webpage.
2. Specify a form in your profile with id A8KQJS6XFFPJ.
<h2>Contact Us</h2>
<form action="http://www.SnapHost.com/captcha/WebFormSubmit.aspx" id="ContactUsCaptchaWebForm" method="post" onsubmit="return ValidateForm(this);">
<input id="SnapHostID" name="SnapHostID" type="hidden" value="A8KQJS6XFFPJ" />
<script type="text/javascript">
function ValidateForm(frm) {
if (frm.FirstName.value == "") {alert('First name is required.');frm.FirstName.focus();return false;}
if (frm.LastName.value == "") {alert('Last name is required.');frm.LastName.focus();return false;}
if (frm.FromEmailAddress.value == "") {alert('Email address is required.');frm.FromEmailAddress.focus();return false;}
if (frm.FromEmailAddress.value.indexOf("@") < 1 || frm.FromEmailAddress.value.indexOf(".") < 1) {alert('Please enter a valid email address.');frm.FromEmailAddress.focus();return false;}
if (frm.Comments.value == "") {alert('Please enter comments or questions.');frm.Comments.focus();return false;}
if (frm.skip_CaptchaCode.value == "") {alert('Enter web form code.');frm.skip_CaptchaCode.focus();return false;}
return true; }
</script>
<table border="0" cellpadding="5" cellspacing="0" width="520">
<tr><td style="width:50%">First name*:<br />
<input id="FirstName" name="FirstName" type="text" maxlength="60" style="width:240px; border:1px solid #009900" /></td>
<td style="width:50%">Last name*:<br />
<input id="LastName" name="LastName" type="text" maxlength="60" style="width:240px; border:1px solid #009900" /></td>
</tr><tr>
<td>Email address*:<br />
<input id="FromEmailAddress" name="FromEmailAddress" type="text" maxlength="60" style="width:240px; border:1px solid #009900" /></td>
<td> </td>
</tr><tr>
<td>Work phone number:<br />
<input id="WorkPhoneNumber" name="WorkPhoneNumber" type="text" maxlength="60" style="width:240px; border:1px solid #009900" /></td>
<td>Fax number:<br />
<input id="FaxNumber" name="FaxNumber" type="text" maxlength="60" style="width:240px; border:1px solid #009900" /></td>
</tr><tr>
<td>Home phone number:<br />
<input id="HomePhoneNumber" name="HomePhoneNumber" type="text" maxlength="60" style="width:240px; border:1px solid #009900" /></td>
<td>Mobile phone number:<br />
<input id="MobilePhoneNumber" name="MobilePhoneNumber" type="text" maxlength="60" style="width:240px; border:1px solid #009900" /></td>
</tr><tr>
<td colspan="2">Address:<br />
<input id="Address" name="Address" type="text" maxlength="250" style="width:500px; border:1px solid #009900" /></td>
</tr><tr>
<td>City:<br />
<input id="City" name="City" type="text" maxlength="60" style="width:240px; border:1px solid #009900" /></td>
<td>State / Province / Region:<br />
<input id="State" name="State" type="text" maxlength="60" style="width:240px; border:1px solid #009900" /></td>
</tr><tr>
<td>Country:<br />
<input id="Country" name="Country" type="text" maxlength="60" style="width:240px; border:1px solid #009900" /></td>
<td>ZIP / Postal code:<br />
<input id="Zip" name="Zip" type="text" maxlength="60" style="width:240px; border:1px solid #009900" /></td>
</tr><tr>
<td colspan="2">Comments and questions*:<br />
<textarea name="Comments" id="Comments" rows="7" cols="40" style="width:500px; border:1px solid #009900"></textarea></td>
</tr><tr>
<td colspan="2" align="center"> <br />
<table border="0" cellpadding="0" cellspacing="0">
<tr valign="top">
<td> <i>Enter web form code*:</i>
<input id="CaptchaCode" name="CaptchaCode" type="text" style="width:80px; border:1px solid #999999" maxlength="6" />
</td><td>
<a href="http://www.SnapHost.com/captcha/ProCaptchaOverview.aspx"><img alt="Web Form Code"
style="margin-left:20px; border:1px solid #999999"
src="http://www.SnapHost.com/captcha/WebForm.aspx?id=A8KQJS6XFFPJ&ImgType=2" /></a>
</td></tr>
</table> <br />
* - required fields.
<input id="skip_Submit" name="skip_Submit" type="submit" value="Submit" />
</td></tr>
</table><br />
</form>
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