File size: 8,431 Bytes
32030c0 ce71e7f 32030c0 ce71e7f 9fbc822 32030c0 ce71e7f 32030c0 9fbc822 32030c0 9fbc822 32030c0 9fbc822 32030c0 9fbc822 32030c0 9fbc822 32030c0 9fbc822 32030c0 9fbc822 32030c0 9fbc822 32030c0 9fbc822 32030c0 9fbc822 ce71e7f 9fbc822 32030c0 ce71e7f 32030c0 ce71e7f 9fbc822 32030c0 ce71e7f 32030c0 ce71e7f 9fbc822 32030c0 9fbc822 32030c0 ce71e7f 9fbc822 32030c0 9fbc822 32030c0 9fbc822 32030c0 9fbc822 32030c0 9fbc822 32030c0 9fbc822 32030c0 9fbc822 32030c0 9fbc822 32030c0 9fbc822 32030c0 |
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 |
<!-- Automotive Themed Contact Block -->
<div class="w-full flex flex-col items-center mb-8">
<a href="tel:+17154219792"
class="text-2xl font-extrabold text-accent-yellow hover:text-accent-red transition-colors tracking-wide drop-shadow">Call
Hooper Automotive: (715) 421-9792</a>
<span class="text-automotive-200 text-sm mt-1">2020 4th Street South, Wisconsin Rapids, WI 54494 • Wood
County</span>
</div>
<!-- Automotive Quote Request Form -->
<form action="https://formsubmit.co/hooperautorepair70@gmail.com" method="POST"
class="max-w-lg mx-auto bg-automotive-700/90 p-8 rounded-2xl shadow-2xl border-4 border-accent-red space-y-6">
<input type="hidden" name="_cc" value="dondlingergeneralcontracting@gmail.com">
<input type="hidden" name="_captcha" value="false">
<input type="hidden" name="_template" value="table">
<h2 class="text-3xl font-extrabold text-accent-red mb-4 tracking-wide">Request Service Estimate</h2>
<p class="text-automotive-100 mb-4 font-semibold">Get a fast, friendly estimate from Hooper Automotive!<br>Address:
2020 4th Street South, Wisconsin Rapids, WI 54494<br>Phone: <span class="text-accent-yellow">(715)
421-9792</span><br>Email: <a href="mailto:hooperautorepair70@gmail.com"
class="underline text-accent-yellow">hooperautorepair70@gmail.com</a></p>
<div>
<label for="name" class="block text-accent-yellow font-semibold mb-1">Name</label>
<input type="text" id="name" name="name" required
class="w-full px-4 py-2 rounded-lg bg-white/10 border border-automotive-400 text-automotive-50"
placeholder="Your Name">
</div>
<div>
<label for="email" class="block text-accent-yellow font-semibold mb-1">Email</label>
<input type="email" id="email" name="email" required
class="w-full px-4 py-2 rounded-lg bg-white/10 border border-automotive-400 text-automotive-50"
placeholder="you@email.com">
</div>
<div>
<label for="phone" class="block text-accent-yellow font-semibold mb-1">Phone</label>
<input type="tel" id="phone" name="phone"
class="w-full px-4 py-2 rounded-lg bg-white/10 border border-automotive-400 text-automotive-50"
placeholder="(optional)">
</div>
<div>
<label for="service" class="block text-accent-yellow font-semibold mb-1">Service Requested</label>
<select id="service" name="service" required
class="w-full px-4 py-2 rounded-lg bg-white/10 border border-automotive-400 text-automotive-50">
<option value="">Select a service</option>
<option value="Oil Change">Oil Change</option>
<option value="Brake Service">Brake Service</option>
<option value="Transmission Service">Transmission Service</option>
<option value="Engine Diagnostics">Engine Diagnostics</option>
<option value="Tire Service">Tire Service</option>
<option value="Battery Replacement">Battery Replacement</option>
<option value="Air Conditioning">Air Conditioning</option>
<option value="Coolant Service">Coolant Service</option>
<option value="Tune-up">Tune-up</option>
<option value="Exhaust System">Exhaust System</option>
<option value="Suspension Repair">Suspension Repair</option>
<option value="Electrical Diagnosis">Electrical Diagnosis</option>
<option value="Check Engine Light">Check Engine Light</option>
<option value="Pre-purchase Inspection">Pre-purchase Inspection</option>
<option value="State Inspection">State Inspection</option>
<option value="General Repair">General Repair</option>
<option value="Emergency Service">Emergency Service</option>
</select>
</div>
<div>
<label for="vehicle" class="block text-accent-yellow font-semibold mb-1">Vehicle Make/Model/Year</label>
<input type="text" id="vehicle" name="vehicle"
class="w-full px-4 py-2 rounded-lg bg-white/10 border border-automotive-400 text-automotive-50"
placeholder="e.g. 2018 Honda Civic, 2015 Ford F-150">
</div>
<div>
<label for="mileage" class="block text-accent-yellow font-semibold mb-1">Mileage</label>
<input type="text" id="mileage" name="mileage"
class="w-full px-4 py-2 rounded-lg bg-white/10 border border-automotive-400 text-automotive-50"
placeholder="e.g. 85,000 miles">
</div>
<div>
<label for="details" class="block text-accent-yellow font-semibold mb-1">Problem Description</label>
<textarea id="details" name="details" rows="4"
class="w-full px-4 py-2 rounded-lg bg-white/10 border border-automotive-400 text-automotive-50"
placeholder="Describe the issue, symptoms, or service needed..."></textarea>
</div>
<div>
<label class="block text-accent-yellow font-semibold mb-1">Preferred Contact Method</label>
<div class="flex gap-4 mb-2">
<label class="inline-flex items-center"><input type="radio" name="contact_method" value="Phone"
class="mr-2">Phone</label>
<label class="inline-flex items-center"><input type="radio" name="contact_method" value="Email"
class="mr-2">Email</label>
<label class="inline-flex items-center"><input type="radio" name="contact_method" value="Text"
class="mr-2">Text</label>
<label class="inline-flex items-center"><input type="radio" name="contact_method" value="Any"
class="mr-2">Any</label>
</div>
</div>
<div>
<label for="best_time" class="block text-accent-yellow font-semibold mb-1">Best Time to Contact</label>
<select id="best_time" name="best_time"
class="w-full px-4 py-2 rounded-lg bg-white/10 border border-automotive-400 text-automotive-50">
<option value="">Select a time</option>
<option value="Morning">Morning</option>
<option value="Afternoon">Afternoon</option>
<option value="Evening">Evening</option>
<option value="Any">Any</option>
</select>
</div>
<div>
<label for="hear_about" class="block text-accent-yellow font-semibold mb-1">How did you hear about us?</label>
<select id="hear_about" name="hear_about"
class="w-full px-4 py-2 rounded-lg bg-white/10 border border-automotive-400 text-automotive-50">
<option value="">Select an option</option>
<option value="Google Search">Google Search</option>
<option value="Facebook">Facebook</option>
<option value="Instagram">Instagram</option>
<option value="Friend/Family">Friend/Family</option>
<option value="Repeat Customer">Repeat Customer</option>
<option value="Event/Show">Event/Show</option>
<option value="Other">Other</option>
</select>
</div>
<div>
<label class="block text-accent-yellow font-semibold mb-1">How soon do you need this?</label>
<div class="flex gap-2 mb-2">
<label class="inline-flex items-center"><input type="radio" name="urgency" value="ASAP"
class="mr-2">ASAP</label>
<label class="inline-flex items-center"><input type="radio" name="urgency" value="1-2 Weeks"
class="mr-2">1-2 Weeks</label>
<label class="inline-flex items-center"><input type="radio" name="urgency" value="1 Month" class="mr-2">1
Month</label>
<label class="inline-flex items-center"><input type="radio" name="urgency" value="Flexible"
class="mr-2">Flexible</label>
</div>
</div>
<div class="flex items-center mb-2">
<input type="checkbox" id="newsletter" name="newsletter" value="Yes" class="mr-2">
<label for="newsletter" class="text-accent-yellow">Sign me up for news, tips, and special offers!</label>
</div>
<button type="submit"
class="w-full bg-accent-red hover:bg-accent-yellow text-white hover:text-automotive-700 font-extrabold py-4 rounded-lg transition-colors shadow-xl uppercase tracking-wider">Send
Request</button>
</form>
<!-- End Automotive Quote Request Form --> |