Simple lead capture page

This project received 2 bids from talented freelancers with an average bid price of $85 USD.

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Project Budget
$30 - $100 USD
Total Bids
Project Description

I would like a simple lead capture page that plays a short video automatically. In addition to the basic information (Name, email, phone) I would like a drop-down menu for the viewer to select the #1 reason fro visiting the site and what level of interest the viewer has, similar to the lead capture page found here: <[url removed, login to view]> (this lad capture page is rather sophisticated, and I don't need anything this elaborate right now)

I would like to be notified by email when someone provides contact information.

## Deliverables

a simple lead capture page as described above.

## Platform

6.0+ versions of Internet Explorer and 2.0+ versions of Firefox

Skills Required

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