I need a form created from the attached word doc to be put on our website where people can fill out, click submit at the bottom and it will email to us in pdf format.
One note: in the table Excess Liability Insurance – Each Occurrence and Aggregate there needs to be a drop down box with options of 1,000,000 – 2,000,000 – 3,000,000 – 4,000,000 – 5,000,000
