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1 Parent(s): 7f9a1c8

Añade un formulario debajo de este input que tenga estas secciones Full name Business name Email (and Phone optional) Industry (Plumbing, Electrical, HVAC, Lawn care, Clinic, Other) Location/Suburb (Mackay area) Weekly volume (choose ranges) Calls: 0–50 · 51–200 · 201–500 · 501–1,500 · 1,500+ WhatsApp msgs: 0–100 · 101–500 · 501–2,000 · 2,001–5,000 · 5,000+. - Follow Up Deployment

Browse files
Files changed (1) hide show
  1. index.html +91 -0
index.html CHANGED
@@ -895,6 +895,97 @@
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  </button>
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  </div>
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  </div>
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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  <div class="flex justify-center mt-8 space-x-4">
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  <div class="flex items-center text-sm text-gray-400">
 
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  </button>
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  </div>
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  </div>
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+
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+ <div class="glass-card rounded-2xl p-8 mt-8 max-w-2xl mx-auto w-full">
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+ <h3 class="text-xl font-bold mb-6 text-center">Tell us more about your business</h3>
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+ <form class="space-y-4">
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+ <div class="grid md:grid-cols-2 gap-4">
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+ <div>
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+ <label class="block text-sm font-medium mb-1">Full name*</label>
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+ <input type="text" required class="w-full px-4 py-2 rounded-lg bg-dark border border-gray-700 focus:outline-none focus:ring-2 focus:ring-accent">
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+ </div>
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+ <div>
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+ <label class="block text-sm font-medium mb-1">Business name*</label>
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+ <input type="text" required class="w-full px-4 py-2 rounded-lg bg-dark border border-gray-700 focus:outline-none focus:ring-2 focus:ring-accent">
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+ </div>
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+ </div>
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+
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+ <div class="grid md:grid-cols-2 gap-4">
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+ <div>
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+ <label class="block text-sm font-medium mb-1">Email*</label>
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+ <input type="email" required class="w-full px-4 py-2 rounded-lg bg-dark border border-gray-700 focus:outline-none focus:ring-2 focus:ring-accent">
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+ </div>
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+ <div>
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+ <label class="block text-sm font-medium mb-1">Phone (optional)</label>
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+ <input type="tel" class="w-full px-4 py-2 rounded-lg bg-dark border border-gray-700 focus:outline-none focus:ring-2 focus:ring-accent">
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+ </div>
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+ </div>
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+
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+ <div>
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+ <label class="block text-sm font-medium mb-1">Industry*</label>
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+ <select required class="w-full px-4 py-2 rounded-lg bg-dark border border-gray-700 focus:outline-none focus:ring-2 focus:ring-accent">
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+ <option value="">Select your industry</option>
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+ <option>Plumbing</option>
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+ <option>Electrical</option>
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+ <option>HVAC</option>
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+ <option>Lawn care</option>
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+ <option>Clinic</option>
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+ <option>Other</option>
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+ </select>
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+ </div>
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+
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+ <div>
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+ <label class="block text-sm font-medium mb-1">Location/Suburb*</label>
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+ <input type="text" placeholder="Mackay area" required class="w-full px-4 py-2 rounded-lg bg-dark border border-gray-700 focus:outline-none focus:ring-2 focus:ring-accent">
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+ </div>
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+
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+ <div>
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+ <label class="block text-sm font-medium mb-1">Weekly call volume*</label>
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+ <div class="flex flex-wrap gap-2">
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+ <label class="inline-flex items-center">
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+ <input type="radio" name="call_volume" value="0-50" class="mr-2"> 0–50
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+ </label>
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+ <label class="inline-flex items-center">
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+ <input type="radio" name="call_volume" value="51-200" class="mr-2"> 51–200
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+ </label>
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+ <label class="inline-flex items-center">
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+ <input type="radio" name="call_volume" value="201-500" class="mr-2"> 201–500
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+ </label>
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+ <label class="inline-flex items-center">
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+ <input type="radio" name="call_volume" value="501-1500" class="mr-2"> 501–1,500
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+ </label>
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+ <label class="inline-flex items-center">
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+ <input type="radio" name="call_volume" value="1500+" class="mr-2"> 1,500+
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+ </label>
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+ </div>
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+ </div>
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+
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+ <div>
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+ <label class="block text-sm font-medium mb-1">Weekly WhatsApp messages*</label>
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+ <div class="flex flex-wrap gap-2">
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+ <label class="inline-flex items-center">
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+ <input type="radio" name="whatsapp_volume" value="0-100" class="mr-2"> 0–100
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+ </label>
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+ <label class="inline-flex items-center">
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+ <input type="radio" name="whatsapp_volume" value="101-500" class="mr-2"> 101–500
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+ </label>
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+ <label class="inline-flex items-center">
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+ <input type="radio" name="whatsapp_volume" value="501-2000" class="mr-2"> 501–2,000
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+ </label>
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+ <label class="inline-flex items-center">
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+ <input type="radio" name="whatsapp_volume" value="2001-5000" class="mr-2"> 2,001–5,000
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+ </label>
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+ <label class="inline-flex items-center">
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+ <input type="radio" name="whatsapp_volume" value="5000+" class="mr-2"> 5,000+
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+ </label>
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+ </div>
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+ </div>
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+
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+ <button type="submit" class="w-full py-3 mt-6 bg-gradient-to-r from-accent to-accent2 text-dark font-bold rounded-lg hover:opacity-90 transition">
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+ Submit Application
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+ </button>
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+ </form>
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+ </div>
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  <div class="flex justify-center mt-8 space-x-4">
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  <div class="flex items-center text-sm text-gray-400">