Intake Form

Please use this form to enter leads into our CRM.

<form name="insightly_web_to_lead" action="https://staufferandsons.insight.ly/WebToLead/Create" method="post"><input type="hidden" name="formId" value="jyjErjXuYOP9LvwZUfVZEA==" /><label for="insightly_firstName">First Name: </label><input id="insightly_firstName" name="FirstName" type="text"/><br/><label for="insightly_lastName">Last Name: </label><input id="insightly_lastName" name="LastName" type="text"/><br/><label for="insightly_organization">Organization: </label><input id="insightly_organization" name="OrganizationName" type="text"/><br/><label for="email">Email: </label><input id="insightly_Email" name="email" type="text"/><br/><label for="phone">Phone: </label><input id="insightly_Phone" name="phone" type="text"/><br/><label for="insightly_title">Title: </label><input id="insightly_Title" name="Title" type="text"/><br/><label for="Description">Description: </label><textarea id="insightly_Description" name="Description" type="text"></textarea><br/><input type="hidden" id="insightly_ResponsibleUser" name="ResponsibleUser" value="836451"/><input type="hidden" id="insightly_LeadSource" name="LeadSource" value="209184"/><input type="submit" value="Submit"></form>