Questions Form

<link href="https://s3.amazonaws.com/agilecrm/forms/v1/agile-form-min.css" rel="stylesheet"><!-- [et_pb_line_break_holder] --><form class="form-view theme2" id="agile-form" action="https://scanlab.agilecrm.com/formsubmit" method="GET"><!-- [et_pb_line_break_holder] --> <fieldset style="margin:10px 5px 10px 5px"><!-- [et_pb_line_break_holder] --> <div style="display: none; height: 0px; width: 0px;"><!-- [et_pb_line_break_holder] --> <input type="hidden" id="_agile_form_name" name="_agile_form_name" value="Contact Form"><!-- [et_pb_line_break_holder] --> <input type="hidden" id="_agile_domain" name="_agile_domain" value="scanlab"><!-- [et_pb_line_break_holder] --> <input type="hidden" id="_agile_api" name="_agile_api" value="avfic6lk9ev5f1l1bjieq503b8"><!-- [et_pb_line_break_holder] --> <input type="hidden" id="_agile_redirect_url" name="_agile_redirect_url" value="#"><!-- [et_pb_line_break_holder] --> <input type="hidden" id="_agile_confirmation_msg" name="_agile_confirmation_msg" value="Great! Thanks for filling out the form."><!-- [et_pb_line_break_holder] --> <input type="hidden" id="_agile_form_id_tags" name="tags" value="Website Form"><!-- [et_pb_line_break_holder] --> <input type="hidden" id="_agile_form_id" name="_agile_form_id" value="5664164282368000"><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <div style="margin-top:10px; width:100%"><!-- [et_pb_line_break_holder] --> <input maxlength="250" id="agilefield-1" name="first_name" type="text" placeholder="Name"><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <div style="margin-top:10px; width:100%"><!-- [et_pb_line_break_holder] --> <input maxlength="250" id="agilefield-2" name="email" type="email" placeholder="Email"><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <div style="margin-top:10px; width:100%"><!-- [et_pb_line_break_holder] --> <textarea maxlength="250" id="agilefield-3" name="note" placeholder="" style="height:140px;"></textarea><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <div style="margin-top:10px; width:100%"><!-- [et_pb_line_break_holder] --> <button type="submit" style="background-color:#f05a28; border: 2px solid #f01a28; color: #fff; -webkit-border-radius: 3px; text-transform: uppercase; margin-top:10px; padding: 20px;">Send</button><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <span id="agile-error-msg"></span><!-- [et_pb_line_break_holder] --> </fieldset><!-- [et_pb_line_break_holder] --></form><!-- [et_pb_line_break_holder] --><script type="text/javascript"><!-- [et_pb_line_break_holder] -->(function(a){var b=a.onload,p=false;isCaptcha=false;if(p){a.onload="function"!=typeof b?function(){try{_agile_load_form_fields()}catch(a){}}:function(){b();try{_agile_load_form_fields()}catch(a){}}};a.document.forms["agile-form"].onsubmit=function(a){a.preventDefault();try{_agile_synch_form_v4()}catch(b){this.submit()}}})(window);<!-- [et_pb_line_break_holder] --></script>