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<!DOCTYPE html> <html lang="en"> <head> <meta charset="UTF-8"> <meta name="viewport" content="width=device-width, initial-scale=1.0"> <title>Lead Form</title> </head> <body> <h1>Contact Us</h1> <form action="process_form.php" method="POST"> <label for="name">Name:</label> <input type="text" id="name" name="name" required><br><br> <label for="phone">Phone:</label> <input type="tel" id="phone" name="phone" required><br><br> <label for="email">Email:</label> <input type="email" id="email" name="email" required><br><br> <label for="pickup_city">Pick Up City:</label> <input type="text" id="pickup_city" name="pickup_city" required><br><br> <label for="pickup_state">Pick Up State:</label> <input type="text" id="pickup_state" name="pickup_state" required><br><br> <label for="dropoff_city">Drop Off City:</label> <input type="text" id="dropoff_city" name="dropoff_city" required><br><br> <label for="dropoff_state">Drop Off State:</label> <input type="text" id="dropoff_state" name="dropoff_state" required><br><br> <input type="submit" value="Submit"> </form> </body> </html>
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