UPMC BU > CloudPages > API Internal Testing Forms > Presby Construction and Community Resource Center - TEST FORM


      <h2>Presby Construction and Community Resource Center Contact Form - Test Form</h2>
      <form action="https://pages.upmc.com/presby-construction-and-community-api-internal-testing-form" method="post">
         <label>Email</label>
         <input type="text" name="email_address"><br>
         <label>First Name</label>
         <input type="text" name="first_name"><br>
         <label>Last Name</label>
         <input type="text" name="last_name"><br>
         <label>Daytime Phone</label>
         <input type="text" name="phone_number"><br>
         <label>Title</label>
         <input type="text" name="title"><br>
         <label>Company/Organization</label>
         <input type="text" name="company"><br>

         <label>Please select which one best describes you:</label>
            <select name="personal_description" id="personal_description">
               <option value="" selected="selected">Select One</option>
               <option value="A business owner ">A business owner </option>
               <option value="Individual">Individual</option>
               <option value="Organization (nonprofit)">Organization (nonprofit)</option>
            </select><br>

         <label>Would you like to request an appointment with the Resource Center?</label>
            <select name="request_an_appointment" id="request_an_appointment">
               <option value="" selected="selected">Select One</option>
               <option value="Yes">Yes</option>
               <option value="No">No</option>
            </select><br>

         <label>Category</label>
         <input type="text" name="category"><br>
         <label>Subcategory</label>
         <input type="text" name="subcategory"><br>
         <input name="submitted" type="hidden" value="true" />
         <input type="submit" value="Submit">
      </form>