Embed

<!DOCTYPE html>
<html lang="en">
<head>
    <meta charset="UTF-8">
    <meta name="viewport" content="width=device-width, initial-scale=1.0">
    <title>Service Request Form</title>
    <style>
        body { 
            font-family: Arial, sans-serif; 
            margin: 20px; 
            background-color: #f8f9fa;
        }
        .form-container { 
            max-width: 600px; 
            margin: auto; 
            padding: 30px; 
            background: white; 
            border-radius: 15px; 
            box-shadow: 0px 4px 10px rgba(0, 0, 0, 0.1);
        }
        h2 { 
            text-align: center; 
            font-size: 26px; 
        }
        p { 
            text-align: center; 
            font-size: 18px; 
            color: #555;
        }
        label { 
            font-size: 18px; 
            font-weight: bold; 
            display: block; 
            margin-top: 15px; 
        }
        input, select, textarea { 
            width: 100%; 
            padding: 15px; 
            margin-top: 8px; 
            border: 2px solid #ccc; 
            border-radius: 8px; 
            font-size: 16px; 
        }
        textarea { 
            height: 120px; 
            resize: vertical; 
        }
        button { 
            display: block; 
            width: 100%; 
            background: #007bff; 
            color: white; 
            padding: 15px; 
            font-size: 18px; 
            font-weight: bold; 
            border: none; 
            border-radius: 8px; 
            cursor: pointer; 
            margin-top: 20px;
            transition: 0.3s;
        }
        button:hover { 
            background: #0056b3; 
        }
    </style>
</head>
<body>

    <div class="form-container">
        <h2>Request a Quote</h2>
        <p>Fill out the form below, and we’ll get back to you as soon as possible.</p>
        
        <form action="https://formsubmit.co/durtworksllc@gmail.com" method="POST">
            <input type="hidden" name="_captcha" value="false">
            <input type="hidden" name="_template" value="table">
            <input type="hidden" name="_next" value="https://yourwebsite.com/thank-you"> 

            <label for="name">Full Name:</label>
            <input type="text" id="name" name="name" placeholder="John Doe" required>

            <label for="work-description">What exactly are you looking to get done? What problem are you facing?</label>
            <textarea id="work-description" name="work-description" placeholder="Describe the service you need and the issue you're experiencing..." required></textarea>

            <label for="timeframe">How soon do you need this project completed?</label>
            <select id="timeframe" name="timeframe" required>
                <option value="" disabled selected>Select an option</option>
                <option value="Urgently (ASAP)">Urgently (ASAP)</option>
                <option value="Within a week">Within a week</option>
                <option value="Within a month">Within a month</option>
                <option value="Flexible timeframe">Flexible timeframe</option>
            </select>

            <label for="phone">Phone Number:</label>
            <input type="tel" id="phone" name="phone" placeholder="(123) 456-7890" required>

            <label for="email">Email Address:</label>
            <input type="email" id="email" name="email" placeholder="yourname@example.com" required>

            <button type="submit">Submit Request</button>
        </form>
    </div>

</body>
</html>

DURT WORKS LLC.

excavation and demolition contractor