<!– ———————————————————————- –>
<!– 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″>
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<!– NOTE: Please add the following <FORM> element to your page. –>
<!– ———————————————————————- –>
<form action=”https://webto.salesforce.com/servlet/servlet.WebToCase?encoding=UTF-8″ method=”POST”>
<input type=hidden name=”orgid” value=”00DG0000000jkAp”>
<input type=hidden name=”retURL” value=”https://ihccbusiness.net/test-salesforce/”>
<!– ———————————————————————- –>
<!– 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=”arodriguez@ihccbusiness.net”> –>
<!– ———————————————————————- –>
<label for=”name” id=”name_pcl”>Contact Name</label><input aria-labelledby=”name_pcl” id=”name” maxlength=”80″ name=”name” size=”20″ type=”text” /><br>
<label for=”email” id=”email_pcl”>Email</label><input aria-labelledby=”email_pcl” id=”email” maxlength=”80″ name=”email” size=”20″ type=”text” /><br>
<label for=”phone” id=”phone_pcl”>Phone</label><input aria-labelledby=”phone_pcl” id=”phone” maxlength=”40″ name=”phone” size=”20″ type=”text” /><br>
<label for=”subject” id=”subject_pcl”>Subject</label><input aria-labelledby=”subject_pcl” id=”subject” maxlength=”80″ name=”subject” size=”20″ type=”text” /><br>
<label for=”description” id=”description_pcl”>Description</label><textarea name=”description”></textarea><br>
<label for=”status” id=”status_pcl”>Status</label><select aria-labelledby=”status_pcl” id=”status” name=”status”><option value=””>–None–</option><option value=”On Hold”>On Hold</option>
<option value=”Escalated”>Escalated</option>
<option value=”Closed”>Closed</option>
<option value=”New”>New</option>
</select><br>
<label for=”reason” id=”reason_pcl”>Case Reason</label><select aria-labelledby=”reason_pcl” id=”reason” name=”reason”><option value=””>–None–</option><option value=”Complex functionality”>Complex functionality</option>
<option value=”Existing problem”>Existing problem</option>
<option value=”Instructions not clear”>Instructions not clear</option>
<option value=”New problem”>New problem</option>
<option value=”Suggestion for change”>Suggestion for change</option>
</select><br>
<input type=”hidden” id=”external” name=”external” value=”1″ /><br>
<input type=”submit” name=”submit”>
</form>