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<!-- ---------------------------------------------------------------------- -->
<!-- NOTE: Please add the following <META> element to your page <HEAD>. -->
<!-- If necessary, please modify the charset parameter to specify the -->
<!-- character set of your HTML page. -->
<!-- ---------------------------------------------------------------------- -->
<META HTTP-EQUIV="Content-type" CONTENT="text/html; charset=UTF-8">
<!-- ---------------------------------------------------------------------- -->
<!-- NOTE: Please add the following <FORM> element to your page. -->
<!-- ---------------------------------------------------------------------- -->
<form action="https://webto.salesforce.com/servlet/servlet.WebToLead?encoding=UTF-8" method="POST">
<input type=hidden name="oid" value="00D6g0000022aVA">
<input type=hidden name="retURL" value="http://">
<!-- ---------------------------------------------------------------------- -->
<!-- NOTE: These fields are optional debugging elements. Please uncomment -->
<!-- these lines if you wish to test in debug mode. -->
<!-- <input type="hidden" name="debug" value=1> -->
<!-- <input type="hidden" name="debugEmail" value="jon@elod.in"> -->
<!-- ---------------------------------------------------------------------- -->
<label for="first_name">First Name</label><input id="first_name" maxlength="40" name="first_name" size="20" type="text" /><br>
<label for="last_name">Last Name</label><input id="last_name" maxlength="80" name="last_name" size="20" type="text" /><br>
<label for="email">Email</label><input id="email" maxlength="80" name="email" size="20" type="text" /><br>
<label for="company">Company</label><input id="company" maxlength="40" name="company" size="20" type="text" /><br>
<label for="city">City</label><input id="city" maxlength="40" name="city" size="20" type="text" /><br>
<label for="state">State/Province</label><input id="state" maxlength="20" name="state" size="20" type="text" /><br>
<input type="submit" name="submit">
</form>
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