Purlem | Custom Landing Page Form

Advanced users that prefer not to use Purlem's Landing Page form generator, can use the code below to place the form directly into their Purlem landing page. This will give full control to modify the form however you see fit...

A heads up! Any fields that you are using in your custom HTML, will also need to be added to the landing page editor!

<form action="http://www.purlapi.com/lp/submit.php" method="post" accept-charset="utf-8">
First Name<br />
<input type="text" name="Name" value="<?php echo $visitor->{'firstName'}; ?>" class="textbox" /><br />
Last Name<br />
<input type="text" name="lastName" value="<?php echo $visitor->{'lastName'}; ?>" class="textbox" /><br />
Email<br />
<input type="text" name="email" value="<?php echo $visitor->{'email'}; ?>" class="textbox" id="email" /><br />
Company<br />
<input type="text" name="company" value="<?php echo $visitor->{'company'}; ?>" class="textbox" /><br />
Position<br />
<input type="text" name="position" value="<?php echo $visitor->{'position'}; ?>" class="textbox" /><br />
Phone<br />
<input type="text" name="phone" value="<?php echo $visitor->{'phone'}; ?>" class="textbox" /><br />
Address<br />
<input type="text" name="address" value="<?php echo $visitor->{'address'}; ?>" class="textbox" /><br />
City<br />
<input type="text" name="city" value="<?php echo $visitor->{'city'}; ?>" class="textbox" /><br />
State<br />
<input type="text" name="state" value="<?php echo $visitor->{'state'}; ?>" class="textbox" /><br />
Zip<br />
<input type="text" name="zip" value="<?php echo $visitor->{'zip'}; ?>" class="textbox" /><br />
Custom Field<br />
<input type="text" name="customXXXX" value="<?php echo $visitor->{'customXXXX'}; ?>" class="textbox"/><br />
<input type="hidden" name="pageID" value="<?php echo $visitor->{'landingpage_id'}; ?>" />
<input type="hidden" name="nextPage" value="<?php echo $visitor->{'landingpage_form_submit'}; ?>" />
<input type="hidden" name="contactID" value="<?php echo $visitor->{'contact_id'}; ?>" />
<input type="hidden" name="test" value="<?php echo $_GET['test']; ?>" />
<input type="hidden" name="qr" value="<?php echo $_GET['qr']; ?>" />
<input type="hidden" name="platform" value="<?php echo $_GET['platform']; ?>" />
<input type="hidden" name="userID" value="<?php echo $visitor->{'contact_client_id'}; ?>" />
<input type="submit" name="submit" value="Continue" class="button" />
</form>

Customfield ID

To find the customfieldID, rollover the question icon next to the custom field in any Contact's profile page.