www.solution21.com Open in urlscan Pro
143.198.60.115  Public Scan

Submitted URL: http://dentistry21.com/
Effective URL: https://www.solution21.com/
Submission: On September 26 via manual from US — Scanned from DE

Form analysis 1 forms found in the DOM

Name: WebToLeads457238000067524040POST https://crm.zoho.com/crm/WebToLeadForm

<form action="https://crm.zoho.com/crm/WebToLeadForm" name="WebToLeads457238000067524040" method="POST" onsubmit="javascript:document.charset=&quot;UTF-8&quot;; return checkMandatory457238000067524040()" accept-charset="UTF-8" siq_id="autopick_5439">
  <input type="text" style="display:none;" name="xnQsjsdp" value="d0b9b9c8eb3acc99571b5c69ff7ad95984d1a7e2a844f16c4c645f791586cb5c"> <input type="hidden" name="zc_gad" id="zc_gad" value=""> <input type="text" style="display:none;" name="xmIwtLD"
    value="0b8ff4b7b6e55c892bc615006e50588ee3c70071787a4445ce9dc4da3d631317"> <input type="text" style="display:none;" name="actionType" value="TGVhZHM="> <input type="text" style="display:none;" name="returnURL" value="https://www.solution21.com">
  <!-- Do not remove this code. -->
  <style>
    html,
    body {
      margin: 0px;
    }

    #crmWebToEntityForm.zcwf_lblLeft {
      width: 100%;
      padding: 25px;
      margin: 0 auto;
      box-sizing: border-box;
    }

    #crmWebToEntityForm.zcwf_lblLeft * {
      box-sizing: border-box;
    }

    #crmWebToEntityForm {
      text-align: left;
    }

    #crmWebToEntityForm * {
      direction: ltr;
    }

    .zcwf_lblLeft .zcwf_title {
      word-wrap: break-word;
      padding: 0px 6px 10px;
      font-weight: bold;
    }

    .zcwf_lblLeft .zcwf_col_fld input[type=text],
    .zcwf_lblLeft .zcwf_col_fld textarea {
      width: 60%;
      border: 1px solid #ccc !important;
      resize: vertical;
      border-radius: 2px;
      float: left;
    }

    .zcwf_lblLeft .zcwf_col_lab {
      width: 30%;
      word-break: break-word;
      padding: 0px 6px 0px;
      margin-right: 10px;
      margin-top: 5px;
      float: left;
      min-height: 1px;
    }

    .zcwf_lblLeft .zcwf_col_fld {
      float: left;
      width: 68%;
      padding: 0px 6px 0px;
      position: relative;
      margin-top: 5px;
    }

    .zcwf_lblLeft .zcwf_privacy {
      padding: 6px;
    }

    .zcwf_lblLeft .wfrm_fld_dpNn {
      display: none;
    }

    .dIB {
      display: inline-block;
    }

    .zcwf_lblLeft .zcwf_col_fld_slt {
      width: 60%;
      border: 1px solid #ccc;
      background: #fff;
      border-radius: 4px;
      font-size: 12px;
      float: left;
      resize: vertical;
    }

    .zcwf_lblLeft .zcwf_row:after,
    .zcwf_lblLeft .zcwf_col_fld:after {
      content: '';
      display: table;
      clear: both;
    }

    .zcwf_lblLeft .zcwf_col_help {
      float: left;
      margin-left: 7px;
      font-size: 12px;
      max-width: 35%;
      word-break: break-word;
    }

    .zcwf_lblLeft .zcwf_help_icon {
      cursor: pointer;
      width: 16px;
      height: 16px;
      display: inline-block;
      background: #fff;
      border: 1px solid #ccc;
      color: #ccc;
      text-align: center;
      font-size: 11px;
      line-height: 16px;
      font-weight: bold;
      border-radius: 50%;
    }

    .zcwf_lblLeft .zcwf_row {
      margin: 15px 0px;
    }

    .zcwf_lblLeft .formsubmit {
      margin-right: 5px;
      cursor: pointer;
      color: #333;
      font-size: 12px;
    }

    .zcwf_lblLeft .zcwf_privacy_txt {
      color: rgb(0, 0, 0);
      font-size: 12px;
      font-family: Arial;
      display: inline-block;
      vertical-align: top;
      color: #333;
      padding-top: 2px;
      margin-left: 6px;
    }

    .zcwf_lblLeft .zcwf_button {
      font-size: 12px;
      color: #333;
      border: 1px solid #ccc;
      padding: 3px 9px;
      border-radius: 4px;
      cursor: pointer;
      max-width: 120px;
      overflow: hidden;
      text-overflow: ellipsis;
      white-space: nowrap;
    }

    .zcwf_lblLeft .zcwf_tooltip_over {
      position: relative;
    }

    .zcwf_lblLeft .zcwf_tooltip_ctn {
      position: absolute;
      background: #dedede;
      padding: 3px 6px;
      top: 3px;
      border-radius: 4px;
      word-break: break-all;
      min-width: 50px;
      max-width: 150px;
      color: #333;
    }

    .zcwf_lblLeft .zcwf_ckbox {
      float: left;
    }

    .zcwf_lblLeft .zcwf_file {
      width: 55%;
      box-sizing: border-box;
      float: left;
    }

    .clearB:after {
      content: '';
      display: block;
      clear: both;
    }

    @media all and (max-width: 600px) {

      .zcwf_lblLeft .zcwf_col_lab,
      .zcwf_lblLeft .zcwf_col_fld {
        width: auto;
        float: none !important;
      }

      .zcwf_lblLeft .zcwf_col_help {
        width: 40%;
      }
    }
  </style>
  <div class="zcwf_title" style="max-width: 600px;color: black;">Website Marketing Analysis</div>
  <div class="zcwf_row">
    <div class="zcwf_col_lab" style="font-size:12px; font-family: Arial;"><label for="First_Name">First Name</label></div>
    <div class="zcwf_col_fld"><input type="text" id="First_Name" name="First Name" maxlength="40">
      <div class="zcwf_col_help"></div>
    </div>
  </div>
  <div class="zcwf_row">
    <div class="zcwf_col_lab" style="font-size:12px; font-family: Arial;"><label for="Last_Name">Last Name<span style="color:red;">*</span></label></div>
    <div class="zcwf_col_fld"><input type="text" id="Last_Name" name="Last Name" maxlength="80">
      <div class="zcwf_col_help"></div>
    </div>
  </div>
  <div class="zcwf_row">
    <div class="zcwf_col_lab" style="font-size:12px; font-family: Arial;"><label for="Phone">Phone<span style="color:red;">*</span></label></div>
    <div class="zcwf_col_fld"><input type="text" id="Phone" name="Phone" maxlength="30">
      <div class="zcwf_col_help"></div>
    </div>
  </div>
  <div class="zcwf_row">
    <div class="zcwf_col_lab" style="font-size:12px; font-family: Arial;"><label for="Email">Email<span style="color:red;">*</span></label></div>
    <div class="zcwf_col_fld"><input type="text" ftype="email" id="Email" name="Email" maxlength="100">
      <div class="zcwf_col_help"></div>
    </div>
  </div>
  <div class="zcwf_row">
    <div class="zcwf_col_lab" style="font-size:12px; font-family: Arial;"><label for="Website">Website<span style="color:red;">*</span></label></div>
    <div class="zcwf_col_fld"><input type="text" id="Website" name="Website" maxlength="255">
      <div class="zcwf_col_help"></div>
    </div>
  </div>
  <div class="zcwf_row">
    <div class="zcwf_col_lab"></div>
    <div class="zcwf_col_fld">
      <div class="g-recaptcha" data-sitekey="6Lc_pq0bAAAAAC7D8PpbAJml2PbIjaExFl1x-f3A" data-theme="light" data-callback="rccallback457238000067524040" captcha-verified="false" id="recap457238000067524040">
        <div style="width: 304px; height: 78px;">
          <div><iframe title="reCAPTCHA"
              src="https://www.google.com/recaptcha/api2/anchor?ar=1&amp;k=6Lc_pq0bAAAAAC7D8PpbAJml2PbIjaExFl1x-f3A&amp;co=aHR0cHM6Ly93d3cuc29sdXRpb24yMS5jb206NDQz&amp;hl=de&amp;v=ovmhLiigaw4D9ujHYlHcKKhP&amp;theme=light&amp;size=normal&amp;cb=l2vls9z2wgrq"
              width="304" height="78" role="presentation" name="a-u7n5ngosmgq2" frameborder="0" scrolling="no"
              sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"></iframe></div><textarea id="g-recaptcha-response" name="g-recaptcha-response"
            class="g-recaptcha-response" required="required" style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
        </div><iframe style="display: none;"></iframe>
      </div>
      <div id="recapErr457238000067524040" style="font-size:12px;color:red;visibility:hidden;">Captcha validation failed. If you are not a robot then please try again.</div>
    </div>
  </div>
  <div class="zcwf_row">
    <div class="zcwf_col_lab"></div>
    <div class="zcwf_col_fld"><input type="submit" id="formsubmit" class="formsubmit zcwf_button" value="Submit" title="Submit"><input type="reset" class="zcwf_button" name="reset" value="Reset" title="Reset"></div>
  </div>
  <script>
    /* Do not remove this code. */
    function rccallback457238000067524040() {
      if (document.getElementById('recap457238000067524040') != undefined) {
        document.getElementById('recap457238000067524040').setAttribute('captcha-verified', true);
      }
      if (document.getElementById('recapErr457238000067524040') != undefined && document.getElementById('recapErr457238000067524040').style.visibility == 'visible') {
        document.getElementById('recapErr457238000067524040').style.visibility = 'hidden';
      }
    }

    function reCaptchaAlert457238000067524040() {
      var recap = document.getElementById('recap457238000067524040');
      if (recap != undefined && recap.getAttribute('captcha-verified') == 'false') {
        document.getElementById('recapErr457238000067524040').style.visibility = 'visible';
        return false;
      }
      return true;
    }

    function validateEmail457238000067524040() {
      var form = document.forms['WebToLeads457238000067524040'];
      var emailFld = form.querySelectorAll('[ftype=email]');
      var i;
      for (i = 0; i < emailFld.length; i++) {
        var emailVal = emailFld[i].value;
        if ((emailVal.replace(/^\s+|\s+$/g, '')).length != 0) {
          var atpos = emailVal.indexOf('@');
          var dotpos = emailVal.lastIndexOf('.');
          if (atpos < 1 || dotpos < atpos + 2 || dotpos + 2 >= emailVal.length) {
            alert('Please enter a valid email address. ');
            emailFld[i].focus();
            return false;
          }
        }
      }
      return true;
    }

    function checkMandatory457238000067524040() {
      var mndFileds = new Array('Last Name', 'Email', 'Phone', 'Website');
      var fldLangVal = new Array('Last Name', 'Email', 'Phone', 'Website');
      for (i = 0; i < mndFileds.length; i++) {
        var fieldObj = document.forms['WebToLeads457238000067524040'][mndFileds[i]];
        if (fieldObj) {
          if (((fieldObj.value).replace(/^\s+|\s+$/g, '')).length == 0) {
            if (fieldObj.type == 'file') {
              alert('Please select a file to upload.');
              fieldObj.focus();
              return false;
            }
            alert(fldLangVal[i] + ' cannot be empty.');
            fieldObj.focus();
            return false;
          } else if (fieldObj.nodeName == 'SELECT') {
            if (fieldObj.options[fieldObj.selectedIndex].value == '-None-') {
              alert(fldLangVal[i] + ' cannot be none.');
              fieldObj.focus();
              return false;
            }
          } else if (fieldObj.type == 'checkbox') {
            if (fieldObj.checked == false) {
              alert('Please accept  ' + fldLangVal[i]);
              fieldObj.focus();
              return false;
            }
          }
          try {
            if (fieldObj.name == 'Last Name') {
              name = fieldObj.value;
            }
          } catch (e) {}
        }
      }
      if (!validateEmail457238000067524040()) {
        return false;
      }
      if (!reCaptchaAlert457238000067524040()) {
        return false;
      }
      document.querySelector('.crmWebToEntityForm .formsubmit').setAttribute('disabled', true);
    }

    function tooltipShow457238000067524040(el) {
      var tooltip = el.nextElementSibling;
      var tooltipDisplay = tooltip.style.display;
      if (tooltipDisplay == 'none') {
        var allTooltip = document.getElementsByClassName('zcwf_tooltip_over');
        for (i = 0; i < allTooltip.length; i++) {
          allTooltip[i].style.display = 'none';
        }
        tooltip.style.display = 'block';
      } else {
        tooltip.style.display = 'none';
      }
    }
  </script>
</form>

Text Content

 * sales@solution21.com


Toll Free : 888-423-9235

 * About Us
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Increasing Brand Connect with your existing & potential customers to drive
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Most dentists, plastic surgeons or physicians today know that they must have an
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Providers

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 * Remarketing
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