Jira Code: CCH-1
The online form is placed in the e-commerce website of the client as an iframe when the user submits the form, a new lead will be created in NetSuite.
<nlform>
<html>
<head>
<title>BECOME A WHOLESALE BUYER</title>
</head>
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.3.1/jquery.min.js"></script>
<link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/limonte-sweetalert2/7.33.1/sweetalert2.min.css">
<script src="https://cdnjs.cloudflare.com/ajax/libs/limonte-sweetalert2/7.33.1/sweetalert2.min.js"></script>
<style>
.form {
width: 98%;
}
body{
font-family: "Lato", sans-serif;
}
input[type=text],
input[type=number],
textarea,
select {
width: 100%;
padding: 12px 20px;
margin: 8px 0;
font-size: 15px !important;
font-family: "Lato", sans-serif;
display: inline-block;
border: 1px solid #ccc;
border-radius: 4px;
box-sizing: border-box;
}
.labels {
clear: both;
color: #5E5E5A;
font-size: 15px;
text-transform: uppercase;
font-family: "Lato", sans-serif;
font-weight: 600;
}
.req {
color: #E24F3F;
margin-left: 4px;
}
.heading {
color: #e24f3f;
font-weight: bold;
font-size: 20px;
text-transform: uppercase;
font-family: "Lato", sans-serif;
}
.subheading{
color: #e24f3f;
font-weight: bold;
font-size: 17px;
text-transform: uppercase;
font-family: "Lato", sans-serif;
}
.division {
width: 48%;
padding: 5px;
display: inline-block;
}
@media only screen and (max-width: 1017px) {
.division {
width: 47%;
}
}
@media only screen and (max-width: 767px) {
.division {
width: 100%;
}
}
.line {
color: "#777";
}
.sentence{
font-size: 14px;
color: #5E5E5A;
font-weight: 700;
margin-top: 15px;
font-family: "Lato", sans-serif;
}
.inputfile{
border: 1px solid #ccc;
border-style: dashed;
width: 100%;
height: 150px;
background-color: #f5f5f3;
}
input[type=file] {
color: transparent;
font-family: "Lato", sans-serif;
margin-top: 25px;
}
input[type=file]::-webkit-file-upload-button {
visibility: hidden;
font-family: "Lato", sans-serif;
}
input[type=file] {
content: 'Select files';
color: #fff;
display: inline-block;
font-family: "Lato", sans-serif;
background: #e24f3f;
border-radius: 3px;
padding: 15px 0px;
cursor: pointer;
font-weight: 700;
font-size: 16px;
}
input[type=file]:active {
border: none;
}
input[type=file]:focus {
border: none;
}
.filecontainer{
text-align: center;
margin-top: 20px;
}
.radio{
display: inline-block;
font-size: 16px;
font-family: "Lato", sans-serif;
color: #222;
font-weight: 700;
}
textarea{
margin: 8px 5px;
}
.textarea1 {
width: 100%;
height: 150px;
padding: 12px 20px;
box-sizing: border-box;
font-family: "Lato", sans-serif;
border: 2px solid #ccc;
border-radius: 4px;
background-color: #f8f8f8;
font-size: 16px;
resize: none;
}
input[type=submit] {
background-color: #e24f3f;
border: none;
color: white;
padding: 16px 32px;
text-decoration: none;
margin: 4px 2px;
cursor: pointer;
font-weight: 700;
font-size: 15px;
font-family: "Lato", sans-serif;
}
.save{
background-color: #e24f3f;
border: none;
color: white;
padding: 16px 32px;
text-decoration: none;
margin: 4px 2px;
cursor: pointer;
font-weight: 700;
font-size: 15px;
font-family: "Lato", sans-serif;
}
</style>
<body>
<div class="form">
<form id="LeadForm" name="LeadForm">
<p class="heading">company information</p>
<hr class="line">
<div class="division">
<label class="labels">company name<span class="req">*</span></label>
<nlcompanyname>
</nlcompanyname>
</div>
<div class="division">
<label class="labels">contact name<span class="req">*</span></label>
<input type="text" id="contactName">
</div>
<div style="display: none;">
<nlfirstname>
<nllastname>
</nllastname>
</nlfirstname>
</div>
<div class="division">
<label class="labels">type of business<span class="req">*</span></label>
<select id="category">
<option value="1">Retail (Brick & Mortar)</option>
<option value="2">Retail (Online)</option>
<option value="8">Closeout/Liquidation</option>
<option value="19">Hosp Distributor</option>
<option value="18">Hospitality with Retail</option>
<option value="3">Hospitality/Hotel/Restaurant</option>
<option value="12">Interior Design</option>
<option value="14">International Distributor</option>
<option value="13">International Retailer</option>
<option value="10">Media/Publication</option>
<option value="9">Non Profit/Educational</option>
<option value="4">Party Rental</option>
<option value="11">Private Individual</option>
<option value="16">Promotional</option>
<option value="6">Retail National/Large Chain</option>
</select>
</div>
<div class="division">
<label class="labels">RESALE LICENSE OR BUSINESS LICENSE NUMBER<span class="req">*</span></label>
<input type="text" id="resale">
</div>
<div class="division">
<label class="labels">company website</label>
<nlurl>
</nlurl>
</div>
<div class="division">
<label class="labels">contact email<span class="req">*</span></label>
<nlcustentity_jj_contactemail>
</nlcustentity_jj_contactemail>
</div>
<div class="division" style="width: 100%">
<p class="subheading">PLEASE UPLOAD YOUR RESALE OR BUSINESS LICENSE HERE</p>
<label class="labels">file</label>
<div class="inputfile" id="drop-zone">
<div id="clickHere">
<div style="text-align: center;">
<p class="sentence">Drop Your Files Here</p>
<nlfile>
</nlfile>
</div>
</div>
</div>
<p style="margin-top: 10px;" class="sentence" id="filename"></p>
<p class="sentence">California Only: Download Blank CA Resale Cert <a style="color:#e24f3f" href="https://crowcanyonhome.com/wp-content/uploads/2017/12/Blank-CA-Resale-Cert.pdf ">here,</a> and upload completed form, or email to <a style="color:#e24f3f" href="mailto:info@crowcanyonhome.com">info@crowcanyonhome.com</a></p>
</div>
<div class="division">
<label class="labels">how did you hear about us?<span class="req">*</span></label>
<select id="source">
<option value="-5">Trade Show</option>
<option value="4301">Magazine</option>
<option value="-6">Web Search</option>
<option value="786">Word of Mouth</option>
<option value="1655">Facebook</option>
<option value="1654">Instagram</option>
<option value="1656">Pinterest</option>
</select>
</div>
<br>
<div style="margin-top: 10px;">
<p class="heading">billing information</p>
<hr class="line">
<div class="division">
<label class="labels">company name<span class="req">*</span></label>
<input type="text" id="billCompany" name="billCompany" required="">
</div>
<div class="division">
<label class="labels">billing contact</label>
<input type="text" id="billName">
</div>
<div class="division">
<label class="labels">billing email address<span class="req">*</span></label>
<nlemail>
</nlemail>
</div>
<div class="division">
<label class="labels">billing phone number<span class="req">*</span></label>
<input type="text" id="billPhone">
</div>
<p class="labels" style="font-size: 17px;">BILLING ADDRESS (NO PO BOXES PLEASE)<span class="req">*</span></p>
<div class="division" style="width: 96%">
<label class="labels">street address<span class="req">*</span></label>
<input type="text" id="billStreet">
</div>
<div class="division" style="width: 96%">
<label class="labels">address line 2</label>
<input type="text" id="billAddress">
</div>
<div class="division">
<label class="labels">city<span class="req">*</span></label>
<input type="text" id="city">
</div>
<div class="division" id="USState">
<label class="labels">STATE / PROVINCE / REGION<span class="req">*</span></label>
<input type="text" id="billState">
</div>
<div class="division">
<label class="labels">POSTAL / ZIP CODE<span class="req">*</span></label>
<input type="text" id="billZip">
</div>
<div class="division">
<label class="labels">COUNTRY<span class="req">*</span></label>
<select id="billCountry">
<option value="AF">Afghanistan</option>
<option value="AX">Åland Islands</option>
<option value="AL">Albania</option>
<option value="DZ">Algeria</option>
<option value="AS">American Samoa</option>
<option value="AD">Andorra</option>
<option value="AO">Angola</option>
<option value="AI">Anguilla</option>
<option value="AQ">Antarctica</option>
<option value="AG">Antigua and Barbuda</option>
<option value="AR">Argentina</option>
<option value="AM">Armenia</option>
<option value="AW">Aruba</option>
<option value="AU">Australia</option>
<option value="AT">Austria</option>
<option value="AZ">Azerbaijan</option>
<option value="BS">Bahamas</option>
<option value="BH">Bahrain</option>
<option value="BD">Bangladesh</option>
<option value="BB">Barbados</option>
<option value="BY">Belarus</option>
<option value="BE">Belgium</option>
<option value="BZ">Belize</option>
<option value="BJ">Benin</option>
<option value="BM">Bermuda</option>
<option value="BT">Bhutan</option>
<option value="BO">Bolivia, Plurinational State of</option>
<option value="BQ">Bonaire, Sint Eustatius and Saba</option>
<option value="BA">Bosnia and Herzegovina</option>
<option value="BW">Botswana</option>
<option value="BV">Bouvet Island</option>
<option value="BR">Brazil</option>
<option value="IO">British Indian Ocean Territory</option>
<option value="BN">Brunei Darussalam</option>
<option value="BG">Bulgaria</option>
<option value="BF">Burkina Faso</option>
<option value="BI">Burundi</option>
<option value="KH">Cambodia</option>
<option value="CM">Cameroon</option>
<option value="CA">Canada</option>
<option value="CV">Cape Verde</option>
<option value="KY">Cayman Islands</option>
<option value="CF">Central African Republic</option>
<option value="TD">Chad</option>
<option value="CL">Chile</option>
<option value="CN">China</option>
<option value="CX">Christmas Island</option>
<option value="CC">Cocos (Keeling) Islands</option>
<option value="CO">Colombia</option>
<option value="KM">Comoros</option>
<option value="CG">Congo</option>
<option value="CD">Congo, the Democratic Republic of the</option>
<option value="CK">Cook Islands</option>
<option value="CR">Costa Rica</option>
<option value="CI">Côte d'Ivoire</option>
<option value="HR">Croatia</option>
<option value="CU">Cuba</option>
<option value="CW">Curaçao</option>
<option value="CY">Cyprus</option>
<option value="CZ">Czech Republic</option>
<option value="DK">Denmark</option>
<option value="DJ">Djibouti</option>
<option value="DM">Dominica</option>
<option value="DO">Dominican Republic</option>
<option value="EC">Ecuador</option>
<option value="EG">Egypt</option>
<option value="SV">El Salvador</option>
<option value="GQ">Equatorial Guinea</option>
<option value="ER">Eritrea</option>
<option value="EE">Estonia</option>
<option value="ET">Ethiopia</option>
<option value="FK">Falkland Islands (Malvinas)</option>
<option value="FO">Faroe Islands</option>
<option value="FJ">Fiji</option>
<option value="FI">Finland</option>
<option value="FR">France</option>
<option value="GF">French Guiana</option>
<option value="PF">French Polynesia</option>
<option value="TF">French Southern Territories</option>
<option value="GA">Gabon</option>
<option value="GM">Gambia</option>
<option value="GE">Georgia</option>
<option value="DE">Germany</option>
<option value="GH">Ghana</option>
<option value="GI">Gibraltar</option>
<option value="GR">Greece</option>
<option value="GL">Greenland</option>
<option value="GD">Grenada</option>
<option value="GP">Guadeloupe</option>
<option value="GU">Guam</option>
<option value="GT">Guatemala</option>
<option value="GG">Guernsey</option>
<option value="GN">Guinea</option>
<option value="GW">Guinea-Bissau</option>
<option value="GY">Guyana</option>
<option value="HT">Haiti</option>
<option value="HM">Heard Island and McDonald Islands</option>
<option value="VA">Holy See (Vatican City State)</option>
<option value="HN">Honduras</option>
<option value="HK">Hong Kong</option>
<option value="HU">Hungary</option>
<option value="IS">Iceland</option>
<option value="IN">India</option>
<option value="ID">Indonesia</option>
<option value="IR">Iran, Islamic Republic of</option>
<option value="IQ">Iraq</option>
<option value="IE">Ireland</option>
<option value="IM">Isle of Man</option>
<option value="IL">Israel</option>
<option value="IT">Italy</option>
<option value="JM">Jamaica</option>
<option value="JP">Japan</option>
<option value="JE">Jersey</option>
<option value="JO">Jordan</option>
<option value="KZ">Kazakhstan</option>
<option value="KE">Kenya</option>
<option value="KI">Kiribati</option>
<option value="KP">Korea, Democratic People's Republic of</option>
<option value="KR">Korea, Republic of</option>
<option value="KW">Kuwait</option>
<option value="KG">Kyrgyzstan</option>
<option value="LA">Lao People's Democratic Republic</option>
<option value="LV">Latvia</option>
<option value="LB">Lebanon</option>
<option value="LS">Lesotho</option>
<option value="LR">Liberia</option>
<option value="LY">Libya</option>
<option value="LI">Liechtenstein</option>
<option value="LT">Lithuania</option>
<option value="LU">Luxembourg</option>
<option value="MO">Macao</option>
<option value="MK">Macedonia, the former Yugoslav Republic of</option>
<option value="MG">Madagascar</option>
<option value="MW">Malawi</option>
<option value="MY">Malaysia</option>
<option value="MV">Maldives</option>
<option value="ML">Mali</option>
<option value="MT">Malta</option>
<option value="MH">Marshall Islands</option>
<option value="MQ">Martinique</option>
<option value="MR">Mauritania</option>
<option value="MU">Mauritius</option>
<option value="YT">Mayotte</option>
<option value="MX">Mexico</option>
<option value="FM">Micronesia, Federated States of</option>
<option value="MD">Moldova, Republic of</option>
<option value="MC">Monaco</option>
<option value="MN">Mongolia</option>
<option value="ME">Montenegro</option>
<option value="MS">Montserrat</option>
<option value="MA">Morocco</option>
<option value="MZ">Mozambique</option>
<option value="MM">Myanmar</option>
<option value="NA">Namibia</option>
<option value="NR">Nauru</option>
<option value="NP">Nepal</option>
<option value="NL">Netherlands</option>
<option value="NC">New Caledonia</option>
<option value="NZ">New Zealand</option>
<option value="NI">Nicaragua</option>
<option value="NE">Niger</option>
<option value="NG">Nigeria</option>
<option value="NU">Niue</option>
<option value="NF">Norfolk Island</option>
<option value="MP">Northern Mariana Islands</option>
<option value="NO">Norway</option>
<option value="OM">Oman</option>
<option value="PK">Pakistan</option>
<option value="PW">Palau</option>
<option value="PS">Palestinian Territory, Occupied</option>
<option value="PA">Panama</option>
<option value="PG">Papua New Guinea</option>
<option value="PY">Paraguay</option>
<option value="PE">Peru</option>
<option value="PH">Philippines</option>
<option value="PN">Pitcairn</option>
<option value="PL">Poland</option>
<option value="PT">Portugal</option>
<option value="PR">Puerto Rico</option>
<option value="QA">Qatar</option>
<option value="RE">Réunion</option>
<option value="RO">Romania</option>
<option value="RU">Russian Federation</option>
<option value="RW">Rwanda</option>
<option value="BL">Saint Barthélemy</option>
<option value="SH">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="KN">Saint Kitts and Nevis</option>
<option value="LC">Saint Lucia</option>
<option value="MF">Saint Martin (French part)</option>
<option value="PM">Saint Pierre and Miquelon</option>
<option value="VC">Saint Vincent and the Grenadines</option>
<option value="WS">Samoa</option>
<option value="SM">San Marino</option>
<option value="ST">Sao Tome and Principe</option>
<option value="SA">Saudi Arabia</option>
<option value="SN">Senegal</option>
<option value="RS">Serbia</option>
<option value="SC">Seychelles</option>
<option value="SL">Sierra Leone</option>
<option value="SG">Singapore</option>
<option value="SX">Sint Maarten (Dutch part)</option>
<option value="SK">Slovakia</option>
<option value="SI">Slovenia</option>
<option value="SB">Solomon Islands</option>
<option value="SO">Somalia</option>
<option value="ZA">South Africa</option>
<option value="GS">South Georgia and the South Sandwich Islands</option>
<option value="SS">South Sudan</option>
<option value="ES">Spain</option>
<option value="LK">Sri Lanka</option>
<option value="SD">Sudan</option>
<option value="SR">Suriname</option>
<option value="SJ">Svalbard and Jan Mayen</option>
<option value="SZ">Swaziland</option>
<option value="SE">Sweden</option>
<option value="CH">Switzerland</option>
<option value="SY">Syrian Arab Republic</option>
<option value="TW">Taiwan, Province of China</option>
<option value="TJ">Tajikistan</option>
<option value="TZ">Tanzania, United Republic of</option>
<option value="TH">Thailand</option>
<option value="TL">Timor-Leste</option>
<option value="TG">Togo</option>
<option value="TK">Tokelau</option>
<option value="TO">Tonga</option>
<option value="TT">Trinidad and Tobago</option>
<option value="TN">Tunisia</option>
<option value="TR">Turkey</option>
<option value="TM">Turkmenistan</option>
<option value="TC">Turks and Caicos Islands</option>
<option value="TV">Tuvalu</option>
<option value="UG">Uganda</option>
<option value="UA">Ukraine</option>
<option value="AE">United Arab Emirates</option>
<option value="GB">United Kingdom</option>
<option value="US">United States</option>
<option value="UM">United States Minor Outlying Islands</option>
<option value="UY">Uruguay</option>
<option value="UZ">Uzbekistan</option>
<option value="VU">Vanuatu</option>
<option value="VE">Venezuela, Bolivarian Republic of</option>
<option value="VN">Viet Nam</option>
<option value="VG">Virgin Islands, British</option>
<option value="VI">Virgin Islands, U.S.</option>
<option value="WF">Wallis and Futuna</option>
<option value="EH">Western Sahara</option>
<option value="YE">Yemen</option>
<option value="ZM">Zambia</option>
<option value="ZW">Zimbabwe</option>
</select>
</div>
</div>
<div style="margin-top: 10px;">
<p class="heading">shipping information</p>
<hr class="line">
<div class="division">
<label class="labels">company name<span class="req">*</span></label>
<input type="text" id="shipCompany">
</div>
<div class="division">
<label class="labels">ATTENTION</label>
<input type="text" id="shipName">
</div>
<p class="labels" style="font-size: 17px;">SHIPPING ADDRESS (NO PO BOXES PLEASE)<span class="req">*</span></p>
<div class="division" style="width: 96%">
<label class="labels">street address<span class="req">*</span></label>
<input type="text" id="shipStreet">
</div>
<div class="division" style="width: 96%">
<label class="labels">address line 2</label>
<input type="text" id="shipAddress">
</div>
<div class="division">
<label class="labels">city<span class="req">*</span></label>
<input type="text" id="shipCity">
</div>
<div class="division">
<label class="labels">STATE / PROVINCE / REGION<span class="req">*</span></label>
<input type="text" id="shipState">
</div>
<div class="division">
<label class="labels">POSTAL / ZIP CODE<span class="req">*</span></label>
<input type="text" id="shipZip">
</div>
<div class="division">
<label class="labels">COUNTRY<span class="req">*</span></label>
<select id="shipCountry">
<option value="AF">Afghanistan</option>
<option value="AX">Åland Islands</option>
<option value="AL">Albania</option>
<option value="DZ">Algeria</option>
<option value="AS">American Samoa</option>
<option value="AD">Andorra</option>
<option value="AO">Angola</option>
<option value="AI">Anguilla</option>
<option value="AQ">Antarctica</option>
<option value="AG">Antigua and Barbuda</option>
<option value="AR">Argentina</option>
<option value="AM">Armenia</option>
<option value="AW">Aruba</option>
<option value="AU">Australia</option>
<option value="AT">Austria</option>
<option value="AZ">Azerbaijan</option>
<option value="BS">Bahamas</option>
<option value="BH">Bahrain</option>
<option value="BD">Bangladesh</option>
<option value="BB">Barbados</option>
<option value="BY">Belarus</option>
<option value="BE">Belgium</option>
<option value="BZ">Belize</option>
<option value="BJ">Benin</option>
<option value="BM">Bermuda</option>
<option value="BT">Bhutan</option>
<option value="BO">Bolivia, Plurinational State of</option>
<option value="BQ">Bonaire, Sint Eustatius and Saba</option>
<option value="BA">Bosnia and Herzegovina</option>
<option value="BW">Botswana</option>
<option value="BV">Bouvet Island</option>
<option value="BR">Brazil</option>
<option value="IO">British Indian Ocean Territory</option>
<option value="BN">Brunei Darussalam</option>
<option value="BG">Bulgaria</option>
<option value="BF">Burkina Faso</option>
<option value="BI">Burundi</option>
<option value="KH">Cambodia</option>
<option value="CM">Cameroon</option>
<option value="CA">Canada</option>
<option value="CV">Cape Verde</option>
<option value="KY">Cayman Islands</option>
<option value="CF">Central African Republic</option>
<option value="TD">Chad</option>
<option value="CL">Chile</option>
<option value="CN">China</option>
<option value="CX">Christmas Island</option>
<option value="CC">Cocos (Keeling) Islands</option>
<option value="CO">Colombia</option>
<option value="KM">Comoros</option>
<option value="CG">Congo</option>
<option value="CD">Congo, the Democratic Republic of the</option>
<option value="CK">Cook Islands</option>
<option value="CR">Costa Rica</option>
<option value="CI">Côte d'Ivoire</option>
<option value="HR">Croatia</option>
<option value="CU">Cuba</option>
<option value="CW">Curaçao</option>
<option value="CY">Cyprus</option>
<option value="CZ">Czech Republic</option>
<option value="DK">Denmark</option>
<option value="DJ">Djibouti</option>
<option value="DM">Dominica</option>
<option value="DO">Dominican Republic</option>
<option value="EC">Ecuador</option>
<option value="EG">Egypt</option>
<option value="SV">El Salvador</option>
<option value="GQ">Equatorial Guinea</option>
<option value="ER">Eritrea</option>
<option value="EE">Estonia</option>
<option value="ET">Ethiopia</option>
<option value="FK">Falkland Islands (Malvinas)</option>
<option value="FO">Faroe Islands</option>
<option value="FJ">Fiji</option>
<option value="FI">Finland</option>
<option value="FR">France</option>
<option value="GF">French Guiana</option>
<option value="PF">French Polynesia</option>
<option value="TF">French Southern Territories</option>
<option value="GA">Gabon</option>
<option value="GM">Gambia</option>
<option value="GE">Georgia</option>
<option value="DE">Germany</option>
<option value="GH">Ghana</option>
<option value="GI">Gibraltar</option>
<option value="GR">Greece</option>
<option value="GL">Greenland</option>
<option value="GD">Grenada</option>
<option value="GP">Guadeloupe</option>
<option value="GU">Guam</option>
<option value="GT">Guatemala</option>
<option value="GG">Guernsey</option>
<option value="GN">Guinea</option>
<option value="GW">Guinea-Bissau</option>
<option value="GY">Guyana</option>
<option value="HT">Haiti</option>
<option value="HM">Heard Island and McDonald Islands</option>
<option value="VA">Holy See (Vatican City State)</option>
<option value="HN">Honduras</option>
<option value="HK">Hong Kong</option>
<option value="HU">Hungary</option>
<option value="IS">Iceland</option>
<option value="IN">India</option>
<option value="ID">Indonesia</option>
<option value="IR">Iran, Islamic Republic of</option>
<option value="IQ">Iraq</option>
<option value="IE">Ireland</option>
<option value="IM">Isle of Man</option>
<option value="IL">Israel</option>
<option value="IT">Italy</option>
<option value="JM">Jamaica</option>
<option value="JP">Japan</option>
<option value="JE">Jersey</option>
<option value="JO">Jordan</option>
<option value="KZ">Kazakhstan</option>
<option value="KE">Kenya</option>
<option value="KI">Kiribati</option>
<option value="KP">Korea, Democratic People's Republic of</option>
<option value="KR">Korea, Republic of</option>
<option value="KW">Kuwait</option>
<option value="KG">Kyrgyzstan</option>
<option value="LA">Lao People's Democratic Republic</option>
<option value="LV">Latvia</option>
<option value="LB">Lebanon</option>
<option value="LS">Lesotho</option>
<option value="LR">Liberia</option>
<option value="LY">Libya</option>
<option value="LI">Liechtenstein</option>
<option value="LT">Lithuania</option>
<option value="LU">Luxembourg</option>
<option value="MO">Macao</option>
<option value="MK">Macedonia, the former Yugoslav Republic of</option>
<option value="MG">Madagascar</option>
<option value="MW">Malawi</option>
<option value="MY">Malaysia</option>
<option value="MV">Maldives</option>
<option value="ML">Mali</option>
<option value="MT">Malta</option>
<option value="MH">Marshall Islands</option>
<option value="MQ">Martinique</option>
<option value="MR">Mauritania</option>
<option value="MU">Mauritius</option>
<option value="YT">Mayotte</option>
<option value="MX">Mexico</option>
<option value="FM">Micronesia, Federated States of</option>
<option value="MD">Moldova, Republic of</option>
<option value="MC">Monaco</option>
<option value="MN">Mongolia</option>
<option value="ME">Montenegro</option>
<option value="MS">Montserrat</option>
<option value="MA">Morocco</option>
<option value="MZ">Mozambique</option>
<option value="MM">Myanmar</option>
<option value="NA">Namibia</option>
<option value="NR">Nauru</option>
<option value="NP">Nepal</option>
<option value="NL">Netherlands</option>
<option value="NC">New Caledonia</option>
<option value="NZ">New Zealand</option>
<option value="NI">Nicaragua</option>
<option value="NE">Niger</option>
<option value="NG">Nigeria</option>
<option value="NU">Niue</option>
<option value="NF">Norfolk Island</option>
<option value="MP">Northern Mariana Islands</option>
<option value="NO">Norway</option>
<option value="OM">Oman</option>
<option value="PK">Pakistan</option>
<option value="PW">Palau</option>
<option value="PS">Palestinian Territory, Occupied</option>
<option value="PA">Panama</option>
<option value="PG">Papua New Guinea</option>
<option value="PY">Paraguay</option>
<option value="PE">Peru</option>
<option value="PH">Philippines</option>
<option value="PN">Pitcairn</option>
<option value="PL">Poland</option>
<option value="PT">Portugal</option>
<option value="PR">Puerto Rico</option>
<option value="QA">Qatar</option>
<option value="RE">Réunion</option>
<option value="RO">Romania</option>
<option value="RU">Russian Federation</option>
<option value="RW">Rwanda</option>
<option value="BL">Saint Barthélemy</option>
<option value="SH">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="KN">Saint Kitts and Nevis</option>
<option value="LC">Saint Lucia</option>
<option value="MF">Saint Martin (French part)</option>
<option value="PM">Saint Pierre and Miquelon</option>
<option value="VC">Saint Vincent and the Grenadines</option>
<option value="WS">Samoa</option>
<option value="SM">San Marino</option>
<option value="ST">Sao Tome and Principe</option>
<option value="SA">Saudi Arabia</option>
<option value="SN">Senegal</option>
<option value="RS">Serbia</option>
<option value="SC">Seychelles</option>
<option value="SL">Sierra Leone</option>
<option value="SG">Singapore</option>
<option value="SX">Sint Maarten (Dutch part)</option>
<option value="SK">Slovakia</option>
<option value="SI">Slovenia</option>
<option value="SB">Solomon Islands</option>
<option value="SO">Somalia</option>
<option value="ZA">South Africa</option>
<option value="GS">South Georgia and the South Sandwich Islands</option>
<option value="SS">South Sudan</option>
<option value="ES">Spain</option>
<option value="LK">Sri Lanka</option>
<option value="SD">Sudan</option>
<option value="SR">Suriname</option>
<option value="SJ">Svalbard and Jan Mayen</option>
<option value="SZ">Swaziland</option>
<option value="SE">Sweden</option>
<option value="CH">Switzerland</option>
<option value="SY">Syrian Arab Republic</option>
<option value="TW">Taiwan, Province of China</option>
<option value="TJ">Tajikistan</option>
<option value="TZ">Tanzania, United Republic of</option>
<option value="TH">Thailand</option>
<option value="TL">Timor-Leste</option>
<option value="TG">Togo</option>
<option value="TK">Tokelau</option>
<option value="TO">Tonga</option>
<option value="TT">Trinidad and Tobago</option>
<option value="TN">Tunisia</option>
<option value="TR">Turkey</option>
<option value="TM">Turkmenistan</option>
<option value="TC">Turks and Caicos Islands</option>
<option value="TV">Tuvalu</option>
<option value="UG">Uganda</option>
<option value="UA">Ukraine</option>
<option value="AE">United Arab Emirates</option>
<option value="GB">United Kingdom</option>
<option value="US">United States</option>
<option value="UM">United States Minor Outlying Islands</option>
<option value="UY">Uruguay</option>
<option value="UZ">Uzbekistan</option>
<option value="VU">Vanuatu</option>
<option value="VE">Venezuela, Bolivarian Republic of</option>
<option value="VN">Viet Nam</option>
<option value="VG">Virgin Islands, British</option>
<option value="VI">Virgin Islands, U.S.</option>
<option value="WF">Wallis and Futuna</option>
<option value="EH">Western Sahara</option>
<option value="YE">Yemen</option>
<option value="ZM">Zambia</option>
<option value="ZW">Zimbabwe</option>
</select>
</div>
</div>
<div style="margin-top: 10px;">
<label class="labels">delivery location<span class="req">*</span></label>
<div style="margin-top: 10px;width: 100%">
<input class="radio-btn" type="radio" name="addrs" id="Commercial" value="Commercial" checked="checked">
<p class="radio">Commercial</p>
</div>
<div style="width: 100%">
<input class="radio-btn" type="radio" name="addrs" id="Residential" value="Residential">
<p class="radio">Residential</p>
</div>
</div>
<div style="margin-top: 10px;">
<label class="labels">FREIGHT SHIPMENTS: THIS LOCATION...<span class="req">*</span></label>
<div style="margin-top: 10px;width: 100%">
<input class="radio-btn" type="radio" name="aup_payopt1" id="f1" value="dock" checked="checked">
<p class="radio">Has a dock or forklift capable of removing pallets from truck bed</p>
</div>
<div style="width: 100%">
<input class="radio-btn" type="radio" name="aup_payopt1" id="f2" value="forklift">
<p class="radio">No dock or forklift</p>
</div>
</div>
<div style="margin-top: 10px;">
<input class="checkbox" type="checkbox" name="cstm_prdct" id="cstm_prdct">
<label class="labels">Interested in custom product?</label>
</div>
<div style="margin-top: 20px;">
<label class="labels">special instructions</label>
<!-- <textarea class="textarea1" id="message"></textarea>
<div style="display: none;"> -->
<nlcomments>
</nlcomments>
</div>
<nlcustentity1>
<div style="display: none;">
<nlcustomform>
<nlcustentity_jj_jsonvalues>
<nlcustentity_in8_customer_price_level>
<nlweblead>
</nlweblead>
</nlcustentity_in8_customer_price_level>
</nlcustentity_jj_jsonvalues>
</nlcustomform>
</div>
<div style="margin-top: 20px;">
<button type="submit" id="SubmitBtn" value="SUBMIT REQUEST" style="display: none;"></button>
<button class="save" type="button" id="saveForm">SUBMIT REQUEST</button>
</div>
</form>
</nlcustentity1>
</div>
<script>
$(function() {
var zip = /^(?:[A-Z0-9]+([- ]?[A-Z0-9]+)*)?$/;
var phone = /^\s*(?:\+?(\d{1,3}))?[-. (]*(\d{3})[-. )]*(\d{3})[-. ]*(\d{4})(?: *x(\d+))?\s*$/;
var states = { "alabama": "AL", "alaska": "AK", "american samoa": "AS", "arizona": "AZ", "arkansas": "AR", "california": "CA", "colorado": "CO", "connecticut": "CT", "delaware": "DE", "district of columbia": "DC", "federated states of micronesia": "FM", "florida": "FL", "georgia": "GA", "guam": "GU", "hawaii": "HI", "idaho": "ID", "illinois": "IL", "indiana": "IN", "iowa": "IA", "kansas": "KS", "kentucky": "KY", "louisiana": "LA", "maine": "ME", "marshall islands": "MH", "maryland": "MD", "massachusetts": "MA", "michigan": "MI", "minnesota": "MN", "mississippi": "MS", "missouri": "MO", "montana": "MT", "nebraska": "NE", "nevada": "NV", "new hampshire": "NH", "new jersey": "NJ", "new mexico": "NM", "new york": "NY", "north carolina": "NC", "north dakota": "ND", "northern mariana islands": "MP", "ohio": "OH", "oklahoma": "OK", "oregon": "OR", "palau": "PW", "pennsylvania": "PA", "puerto rico": "PR", "rhode island": "RI", "south carolina": "SC", "south dakota": "SD", "tennessee": "TN", "texas": "TX", "utah": "UT", "vermont": "VT", "virgin islands": "VI", "virginia": "VA", "washington": "WA", "west virginia": "WV", "wisconsin": "WI", "wyoming": "WY" };
$('#saveForm').click(function() {
var allfilled = true;
if (!(zip.test($('#billZip').val())) || !(zip.test($('#shipZip').val()))) {
alert('Enter Valid Zip Code');
return;
}
if (!(phone.test($('#billPhone').val()))) {
alert('Enter Valid Phone number');
return;
}
var mandtory = ['contactName', 'category', 'source', 'resale', 'billCompany', 'billPhone', 'billStreet', 'city', 'billCountry', 'billZip', 'billState', 'shipCompany', 'shipStreet', 'shipCity', 'shipCountry', 'shipZip', 'shipState'];
mandtory.forEach(function(keyID) {
if ($('#' + keyID).val().trim() == '') {
allfilled = false;
}
});
if (allfilled) {
$('#customform').val('280');
var fieldArray = [];
var fullObj = {
'ContactName': '',
'Category': '',
'Source': '',
'Bill': {},
'Ship': {},
'Resale': '',
'Residential': 'F',
'Frieght': '',
'CustomProduct': ''
}
if ($('#cstm_prdct').is(":checked")) {
fullObj.CustomProduct = 'T'
} else {
fullObj.CustomProduct = 'F'
}
fullObj.ContactName = $('#contactName').val();
fullObj.Category = $('#category').val();
fullObj.Source = $('#source').val();
fieldArray = ['billCompany', 'billName', 'billPhone', 'billStreet', 'city', 'billAddress', 'billCountry', 'billZip'];
fieldArray.forEach(function(keyID) {
fullObj.Bill[keyID] = $('#' + keyID).val();
});
fieldArray = ['shipCompany', 'shipName', 'shipStreet', 'shipAddress', 'shipCity', 'shipCountry', 'shipZip'];
fieldArray.forEach(function(keyID) {
fullObj.Ship[keyID] = $('#' + keyID).val();
});
fullObj.Resale = $('#resale').val();
if ($('#Residential').is(":checked")) {
fullObj.Residential = 'T';
}
fullObj.Ship['shipPhone'] = $('#billPhone').val();
if ($('#f1').is(":checked")) {
fullObj.Frieght = 'Has a dock or forklift capable of removing pallets from truck bed';
} else {
fullObj.Frieght = 'No dock or forklift';
}
if ($('#billCountry').val() == 'US') {
if (states[$('#billState').val().toLowerCase().trim()]) {
fullObj.Bill['billState'] = states[$('#billState').val().toLowerCase().trim()];
} else {
alert("Enter Valid US Billing State");
return;
}
} else {
fullObj.Bill['billState'] = $('#billState').val();
}
if ($('#shipCountry').val() == 'US') {
if (states[$('#shipState').val().toLowerCase().trim()]) {
fullObj.Ship['shipState'] = states[$('#shipState').val().toLowerCase().trim()];
} else {
alert("Enter Valid US Shipping State");
return;
}
} else {
fullObj.Ship['shipState'] = $('#shipState').val();
}
var name = $('#contactName').val();
name = name.split(/ (.+)/);
if (name.length >= 2) {
$('#firstname').val(name[0]);
$('#lastname').val(name[1]);
} else {
$('#firstname').val(name[0]);
$('#lastname').val(name[0]);
}
//console.log($('#custentity1').val());
$('#weblead_fs_inp').click();
$('#custentity_jj_jsonvalues').val(JSON.stringify(fullObj));
//console.log(JSON.stringify(fullObj));
Swal.fire({
position: 'bottom',
type: 'success',
title: 'Request is being submitted',
text: 'Thank you for your Wholesale Request',
allowOutsideClick: false,
timer: 2000
}).then(function() {
$("#SubmitBtn").click();
});
} else {
alert("Fill All Mandatory Fields");
return;
}
})
});
$(function() {
$('#file_fs .input').attr('multiple', '');
var dropZoneId = "drop-zone";
var buttonId = "clickHere";
var mouseOverClass = "mouse-over";
var dropZone = $("#" + dropZoneId);
var ooleft = dropZone.offset().left;
var ooright = dropZone.outerWidth() + ooleft;
var ootop = dropZone.offset().top;
var oobottom = dropZone.outerHeight() + ootop;
var inputFile = dropZone.find("input");
document.getElementById(dropZoneId).addEventListener("dragover", function(e) {
e.preventDefault();
e.stopPropagation();
dropZone.addClass(mouseOverClass);
var x = e.pageX;
var y = e.pageY;
if (!(x < ooleft || x > ooright || y < ootop || y > oobottom)) {
inputFile.offset({ top: y - 15, left: x - 100 });
}
}, true);
document.getElementById(dropZoneId).addEventListener("drop", function(e) {
E.preventDefault();
$("#" + dropZoneId).removeClass(mouseOverClass);
}, true);
})
</script>
</body>
</html>
</nlform>