Product Registration

<p> </p> <div class="form-wrapper"> <h1>Product Registration</h1> <p class="intro-text">For all products purchased or delivered hereunder, Solatube International, Inc. warrants they are free from defects of workmanship and/or material for a period of time from the date of purchase.</p> <p class="required-legend"><span class="required-asterisk">*</span> = Information Required</p> <form action="YOUR_FORMSPREE_ENDPOINT" method="POST"><fieldset class="contact-info"><legend>Contact Information</legend> <div class="input-group"><label for="first-name">First Name<span class="required-asterisk">*</span></label> <input id="first-name" name="first_name" required="" type="text" /></div> <div class="input-group"><label for="last-name">Last Name<span class="required-asterisk">*</span></label> <input id="last-name" name="last_name" required="" type="text" /></div> <div class="input-group"><label for="email">Email<span class="required-asterisk">*</span></label> <input id="email" name="email" required="" type="email" /></div> <div class="input-group"><label for="phone">Phone</label> <input id="phone" name="phone" type="tel" /></div> </fieldset><fieldset class="address-info"><legend>Address</legend> <div class="input-group"><label for="country">Country<span class="required-asterisk">*</span></label><select id="country" name="country" required=""> <option disabled="disabled" selected="selected" value="">Select Country*</option> <option value="USA">USA</option> <option value="Canada">Canada</option> <option value="Australia">Australia</option> <option value="United Kingdom">United Kingdom</option> <option value="">------------------</option> {/* Add the extensive list from the original form here if needed, or fetch dynamically */} <option value="Afghanistan">Afghanistan</option> <option value="Albania">Albania</option> <option value="Algeria">Algeria</option> {/* ... (add more countries as needed) ... */} <option value="Zimbabwe">Zimbabwe</option> </select></div> <div class="input-group"><label for="address-street">Street Address<span class="required-asterisk">*</span></label> <input id="address-street" name="street_address" required="" type="text" /></div> <div class="input-group"><label for="address-city">City or Town<span class="required-asterisk">*</span></label> <input id="address-city" name="city" required="" type="text" /></div> <div class="input-group"><label for="address-state">State/Province<span class="required-asterisk">*</span></label> {/* Consider dynamically populating this based on country selection */} <input id="address-state" name="state_province" required="" type="text" placeholder="e.g., CA, Ontario" /> {/* Or use a select like the original if primarily US/Canada */} {/*<select id="address-state" name="state_province" required=""> <option disabled="disabled" selected="selected" value="">Select State/Province*</option> <option value="AL">Alabama</option> <option value="AK">Alaska</option> ... (add states/provinces) ...</select>*/}</div> <div class="input-group"><label for="address-zip">Zip/Postal Code<span class="required-asterisk">*</span></label> <input id="address-zip" name="zip_postal_code" required="" type="text" /></div> </fieldset><fieldset class="product-info"><legend>Product Information</legend> <div class="input-group"><label for="application">Application</label><select id="application" name="application"> <option disabled="disabled" selected="selected" value="">Select Application</option> <option value="Residential">Residential</option> <option value="Commercial">Commercial</option> </select></div> <div class="input-group"><label for="purchase-date">Purchase Date<span class="required-asterisk">*</span></label> <input id="purchase-date" name="purchase_date" required="" type="date" /></div> <div class="input-group choice-group"> <div class="input-group choice-group"> </div> </div> <legend>Product(s) Purchased (Select all that apply)</legend> <div class="input-group choice-group"> <ul> <li><input id="prod_160_isn" name="product_purchased[]" type="checkbox" value="160 ISn" /><label for="prod_160_isn">160 ISn Daylighting System</label></li> <li><input id="prod_160_ds" name="product_purchased[]" type="checkbox" value="160 DS" /><label for="prod_160_ds">160 DS Daylighting System</label></li> <li><input id="prod_160_dse" name="product_purchased[]" type="checkbox" value="160 DSe" /><label for="prod_160_dse">160 DSe Daylighting System (eChoice)</label></li> <li><input id="prod_290_isn" name="product_purchased[]" type="checkbox" value="290 ISn" /><label for="prod_290_isn">290 ISn Daylighting System</label></li> <li><input id="prod_290_ds" name="product_purchased[]" type="checkbox" value="290 DS" /><label for="prod_290_ds">290 DS Daylighting System</label></li> <li><input id="prod_290_dse" name="product_purchased[]" type="checkbox" value="290 DSe" /><label for="prod_290_dse">290 DSe Daylighting System (eChoice)</label></li> <li><input id="prod_solar_star" name="product_purchased[]" type="checkbox" value="Solar Star Attic Fan" /><label for="prod_solar_star">Solar Star Attic Fan™</label></li> <li><input id="prod_vent_kit" name="product_purchased[]" type="checkbox" value="Ventilation Add-On Kit" /><label for="prod_vent_kit">Ventilation Add-On Kit</label></li> <li><input id="prod_light_kit" name="product_purchased[]" type="checkbox" value="Light Add-On Kit" /><label for="prod_light_kit">Light Add-On Kit</label></li> <li><input id="prod_dimmer" name="product_purchased[]" type="checkbox" value="Daylight Dimmer" /><label for="prod_dimmer">Daylight Dimmer</label></li> <li><input id="prod_whf" name="product_purchased[]" type="checkbox" value="Whole House Fan" /><label for="prod_whf">Whole House Fan</label></li> {/* Add other products as needed */}</ul> </div> <div class="input-group"><label for="product-other">Other Product(s) (if not listed)</label> <input id="product-other" name="other_product" type="text" /></div> <div class="input-group"><label for="quantity">Total Quantity<span class="required-asterisk">*</span></label> <input id="quantity" min="1" name="total_quantity" required="" type="number" /></div> </fieldset><fieldset class="ratings"><legend>Please Rate Your Experience</legend> <div class="rating-group"><label>Product Quality:</label> <div class="rating-options"><label><input name="rating_quality" type="radio" value="5" /> Excellent</label> <label><input name="rating_quality" type="radio" value="4" /> Pretty good</label> <label><input name="rating_quality" type="radio" value="3" /> Neutral</label> <label><input name="rating_quality" type="radio" value="2" /> Not so great</label> <label><input name="rating_quality" type="radio" value="1" /> Terrible</label></div> </div> <div class="rating-group"><label>Value & Price:</label> <div class="rating-options"><label><input name="rating_value" type="radio" value="5" /> Excellent</label> <label><input name="rating_value" type="radio" value="4" /> Pretty good</label> <label><input name="rating_value" type="radio" value="3" /> Neutral</label> <label><input name="rating_value" type="radio" value="2" /> Not so great</label> <label><input name="rating_value" type="radio" value="1" /> Terrible</label></div> </div> <div class="rating-group"><label>Customer Service:</label> <div class="rating-options"><label><input name="rating_service" type="radio" value="5" /> Excellent</label> <label><input name="rating_service" type="radio" value="4" /> Pretty good</label> <label><input name="rating_service" type="radio" value="3" /> Neutral</label> <label><input name="rating_service" type="radio" value="2" /> Not so great</label> <label><input name="rating_service" type="radio" value="1" /> Terrible</label></div> </div> <div class="rating-group"><label>Ease of Installation:</label> <div class="rating-options"><label><input name="rating_installation" type="radio" value="5" /> Excellent</label> <label><input name="rating_installation" type="radio" value="4" /> Pretty good</label> <label><input name="rating_installation" type="radio" value="3" /> Neutral</label> <label><input name="rating_installation" type="radio" value="2" /> Not so great</label> <label><input name="rating_installation" type="radio" value="1" /> Terrible</label></div> </div> <div class="rating-group"><label>Light Output:</label> <div class="rating-options"><label><input name="rating_light_output" type="radio" value="5" /> Excellent</label> <label><input name="rating_light_output" type="radio" value="4" /> Pretty good</label> <label><input name="rating_light_output" type="radio" value="3" /> Neutral</label> <label><input name="rating_light_output" type="radio" value="2" /> Not so great</label> <label><input name="rating_light_output" type="radio" value="1" /> Terrible</label></div> </div> <div class="rating-group"><label>Appearance:</label> <div class="rating-options"><label><input name="rating_appearance" type="radio" value="5" /> Excellent</label> <label><input name="rating_appearance" type="radio" value="4" /> Pretty good</label> <label><input name="rating_appearance" type="radio" value="3" /> Neutral</label> <label><input name="rating_appearance" type="radio" value="2" /> Not so great</label> <label><input name="rating_appearance" type="radio" value="1" /> Terrible</label></div> </div> </fieldset><fieldset class="final-section"><legend>Final Details</legend> <div class="input-group"><label for="how-heard">How did you hear about us?</label><select id="how-heard" name="how_heard"> <option disabled="disabled" selected="selected" value="">Select one</option> <option value="Email">Email</option> <option value="Presentation">Presentation</option> <option value="Print Advertisement">Print Advertisement</option> <option value="Public Relations">Public Relations</option> <option value="Referral">Referral</option> <option value="Search Engine">Search Engine</option> <option value="Social Media">Social Media</option> <option value="Dealer">Dealer</option> <option value="Trade Show">Trade Show</option> <option value="Other">Other</option> </select></div> <div class="input-group"><label for="how-heard-other">If Other, please specify:</label> <input id="how-heard-other" name="how_heard_other" type="text" /></div> <div class="input-group"><label for="comments">Comments/Questions:</label> <textarea id="comments" name="comments"></textarea></div> <div class="input-group choice-group"> <ul> <li><input id="read-warranty" name="read_warranty" required="" type="checkbox" value="yes" /> <label for="read-warranty">I have read and understand my warranty<span class="required-asterisk">*</span></label></li> <li><input id="keep-updated" name="keep_updated" type="checkbox" value="yes" /> <label for="keep-updated">Yes, keep me up to date on Solatube Products</label></li> </ul> </div> </fieldset>   <div class="form-consent">Thank you for your interest. By clicking SUBMIT, I consent to be contacted by Solatube International and/or a Solatube Independent Dealer and/or a Solatube Affiliate - via phone, email, and/or text regarding my request, even if my number is on a Do-Not-Call list. I agree to the <a href="../privacy-policy" target="_blank" rel="noopener">Privacy Policy and Terms of Use</a>, including binding arbitration. Calls, emails or texts may use an automated system or prerecorded messages (message & data rates may apply, frequency varies; text HELP for help, STOP to cancel). Text frequency may be limited. I have the right to opt out of data sharing and request access or deletion of my data. Consent is not required for services and may be revoked at any time.</div> <button class="submit-button" type="submit">Submit Registration</button></form></div>