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suz5002
Starting Member
30 Posts |
 Posted - October 21 2009 : 23:22:38
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Hi! Can anyone please help me to creat a form in html that looks something like this for our website. I tried to copy and paste a form (see below) I saw online but the format got a little messed up. Basically we would like a calendar that does nothing but show the date. The online scheduler would request that the customer type in their contact info with a date that service was needed by and then a drop down menu to choose the type of service. The auto responder would basically just email the customer back thanking them and telling them that someone will call shortly. Is this possible?
October 2009
Sun Mon Tue Wed Thu Fri Sat
1 2 3
4 5 6 7 8 9 10
11 12 13 14 15 16 17
18 19 20 21
22 23 24
25 26 27 28 29 30 31
Your Name
* First Last
Date of Notarization
* MM / DD / YYYY
Meeting Time
* HH : MM : SS AM PM AM/PM
Your Contact Phone #
* ### - ### - ####
Document Type *
-- Select a Choice -- Affidavit Grant Deed Deed of Trust Power of Attorney Living Will or Trust Advanced Health Directive Loan Documents Other
# of Signatures *
Email Address for Confirmation *
Thanks so much for your help! 
Take care,
Catherine
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