Lead Form Plus Extras

Lead Form Plus Extras
I need to build a form to send leads to a client’s email address.

The form should be almost a replica of the one found on the left-hand side of this page, starting with “We Can Help”:

http://www.markmorales.com/

I will post this form on a blog post found on my website:

http://www.austindwinow.com

The main differences that should be incorporated into my form are:

1) Submit Form button should alternate between two grey-scale shades rather than gold;

2) The option “Video” should be inserted after “Internet Search” for the question, “How did you hear about this Web site?”;

3) The form should post to an email address I provide.

My site will need to host a copy of the disclaimer ( “I have read the disclaimer” radio button).

Please mention the word “volcano” in your reply so that I know you have read the full description. I may need a number of additional forms and back-end scripting if I like your work.

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