<html>
    <head>
        <page-builder-block>
        @php require_once '../app/general/__header__.tpl' @endphp
        <link rel="stylesheet" href="<?= $path['assets_css'] . '/app.css' ?>" />
        <span id="builderCssToken">
        </span>
        </page-builder-block>
    </head>
    <body>
        @php perform_body_tag_open_actions(); @endphp
        Mobile version
		<form method="post" action="ajax.php?method=new_prospect" name="prospect_form1" accept-charset="utf-8" enctype="application/x-www-form-urlencoded;charset=utf-8">

            <p>
                <label>First Name: </label>
                <input type="text" name="firstName" placeholder="First Name" class="required" value="" data-error-message="Please enter your first name!" />
            </p>
            <p>
                <label>Last Name: </label>
                <input type="text" name="lastName" placeholder="Last Name" class="required" value="" data-error-message="Please enter your last name!" />
            </p>
            <p>
                <label>Address: </label>
                <input type="text" name="shippingAddress1" placeholder="Your Address" class="required" value="" data-error-message="Please enter your address!" />
            </p>
            <p>
                <label>Country: </label>
                <select name="shippingCountry" class="required" data-selected="" data-error-message="Please select your country!">
                    <option value="">Select Country</option>
                </select>
            </p>
            <p>
                <label>State: </label>
                <input type="text" name="shippingState" placeholder="Your State" class="required" data-selected="" data-error-message="Please select your state!" readonly />
            </p>
            <p>
                <label>City: </label>
                <input type="text" name="shippingCity" placeholder="Your City" class="required" value="" data-error-message="Please enter your city!" />
            </p>
            <p>
                <label>Zip Code: </label>
                <input type="text" name="shippingZip" placeholder="Zip Code" class="required" value="" data-error-message="Please enter a valid zip code!" />
                <span id="zip-validate" style="display: none"><img src="@php echo $path['assets_images'] @endphp/ajax-loader.gif"></span>
            </p>
            <p>
                <label>Phone: </label>
                <input type="text" name="phone" placeholder="Phone" class="required" data-validate="phone" data-min-length="10" data-max-length="15" value="" data-error-message="Please enter a valid contact number!" />
            </p>
            <p>
                <label>Email: </label>
                <input type="text" name="email" placeholder="Email Address" class="required" value="" 
                       data-validate="email" 
                       data-error-message="Please enter a valid email id!" />
                <span id="mxcheck-placeholder" style="display:none;"><img src="@php echo $path['assets_images'] @endphp/ajax-loader.gif" /></span>
                <span id="mxcheck-message" style="display:none;"></span>
            </p>
            <p>
                <input type="submit" name="create_prospect" value="Rush My Order" />
            </p>
            <p id="loading-indicator" style="display:none;">Processing...</p>
            <p id="crm-response-container" style="display:none;">CRM messages will appear here...</p>
        </form>

        @php require_once '../app/general/__footer_link__.tpl'; @endphp
        <div id="exitpopup-overlay" class="exitpopup-overlay">
            <div id="exit_pop" class="exitpop-content">
                <a href="@php echo get_exit_pop_url('step1', 1); @endphp">
                    <img src="@php echo $path['assets_images'] @endphp/downsell.jpg" />
                </a>
            </div>
        </div>
        @php require_once '../app/general/__scripts__.tpl' @endphp
        @php require_once '../app/general/__analytics__.tpl' @endphp
        @php perform_body_tag_close_actions(); @endphp
    </body>
</html>
