<!DOCTYPE html>
<html lang="en">
<head>
  <meta charset="UTF-8">
  <title>Freedom Boat Club Lead Form</title>
  <meta name="viewport" content="width=device-width, initial-scale=1">
  <style>
    body {
      font-family: Arial, sans-serif;
      background-color: #f8f8f8;
      padding: 20px;
    }
    .y-form {
      background: white;
      padding: 20px;
      border-radius: 6px;
      max-width: 500px;
      margin: 0 auto;
      box-shadow: 0 0 10px rgba(0,0,0,0.1);
    }
    .form-control {
      width: 100%;
      padding: 10px;
      margin-bottom: 15px;
      box-sizing: border-box;
    }
    .presentation-btn {
      background-color: #0074cc;
      color: white;
      padding: 12px 20px;
      border: none;
      cursor: pointer;
      width: 100%;
      font-size: 16px;
      border-radius: 4px;
    }
    .presentation-btn:hover {
      background-color: #005fa3;
    }
    span {
      font-size: 11px;
      color: #555;
    }
  </style>
</head>
<body>

  <form method="post" class="y-form" name="Request Information" action="https://post.salesoptima.com/wcmpost.aspx" onsubmit="return validateRecaptcha(event)">
    <input type="text" name="txtFirstName" placeholder="First Name" class="form-control" required />
    <input type="text" name="txtLastName" placeholder="Last Name" class="form-control" required />
    <input type="email" name="txtEmail" placeholder="Email" class="form-control" required />
    <input type="tel" name="txtMobile" placeholder="Mobile Number" class="form-control"
      pattern="^([0-9]( |-)?)?(\(?[0-9]{3}\)?|[0-9]{3})( |-)?([0-9]{3}( |-)?[0-9]{4}|[a-zA-Z0-9]{7})$"
      title="Phone Number (Format: 999-999-9999)" required />

    <div style="padding-bottom:10px;">
      <select class="form-control mb-7" name="LinkCode" id="LinkCode" required onchange="onLocationChange()">
        <option value="">-Select Location-</option>
        <option value="H2REXZ1WARERGSEXAJJNHDYNW9YN" data-class5="8750">DE - Bear</option>
        <option value="CN4UTTGGOQ4OP/J1GHK6GOPMMEUN" data-class5="9051">DE - Dewey Beach</option>
        <option value="BBMVCYNUBQ2EJOVYMM/ZLJ5WRXAN" data-class5="8555">DE - Lewes</option>
        <option value="MNMLLKMNOBWMLF7JEGSOLEZSB1EN" data-class5="8610">DE - Long Neck</option>
        <option value="KIZBUF/AMVSD0YOVRNHCYLA/P/AN" data-class5="8478">DC - Washington, D.C.</option>
        <option value="O2JAVWHZ2NNLP3/Y3PZBTY4WA4IN" data-class5="8350">MD - Annapolis</option>
        <option value="BD3I4W5VETR32HD8FRKBBAPQI4ON" data-class5="8477">MD - Baltimore</option>
        <option value="T/TRTXGCD2JPEUXRLR3GHUAEZN0N" data-class5="8578">MD - Deale</option>
        <option value="X3P8MPED9MPGKJG19YKUKXKLXWEN" data-class5="8886">MD - Edgewater</option>
        <option value="XPBMYKPQIFVJAHE2IBHYNXO4OSAN" data-class5="8763">MD - Kent Island</option>
        <option value="8DGVXYXTUIRGXDWW2ZPTWTDGRKUN" data-class5="8744">NJ - Cape May</option>
        <option value="VA6B/SXUTXHUIG4MVUJK7OZWEJSN" data-class5="8821">NJ - Delran</option>
        <option value="XW/COPU9OGDCEGXLWDJI1/YMGWQN" data-class5="9176">NJ - Margate City</option>
        <option value="PRXFAWNSXQTVWL28XKJFFWRYDD4N" data-class5="8973">NJ - Sea Isle City</option>
        <option value="B9TNQJJLPKJMWVKBGHSJABV5MOYN" data-class5="8676">NJ - Somers Point</option>
      <option value="AMLVDGIVYJLMQA5OLYZZTRPWEASN" data-class5="9146">NJ - Jersey City</option>
    <option value="F8Q4PTN/P4FTKTAABKOBRKR9EU0N" data-class5="8817">NY - Haverstraw</option>
    <option value="GGMLOPCLXWHOGP/XBXMY46MWU6AN" data-class5="8818">NY - Ossining</option>
    <option value="GAENGVIKJSQXKJYTRYQITQR5JJSN" data-class5="8851">NY - Piermont</option>
      </select>
    </div>

    <input type="hidden" name="txtAddTag" value="info.fbc-PH_Extension" />
    <input type="hidden" name="txtClass1" value="22401" />
    <input type="hidden" name="txtClass5" value="0" />
    <input type="hidden" name="txtClass2" value="19871" />
    <input type="hidden" name="txtClass4" value="10616" />
    <input type="hidden" name="txtClass7" value="3590" />
    <input type="hidden" name="txtContactSettings" value="3" />
    <input type="hidden" name="txtContactOverWrite" value="0" />

    <!-- reCAPTCHA: shown and rendered after a location is picked -->
    <div id="recaptcha-container" style="display:none; margin-bottom:10px;">
      <div id="fbc-recaptcha"></div>
    </div>

    <span>Valid mobile number required to view info.</span>
    <button class="presentation-btn" type="submit">View Presentation Now!</button>
  <input name='txtCheckToken' type='hidden' value='pykkkdxjdklkdjhljpepe' /></form>

<!-- reCAPTCHA library: only loads if the page hasn't loaded it already -->
<script>
  (function () {
    if (!document.querySelector('script[src*="recaptcha/api.js"]')) {
      var s = document.createElement("script");
      s.src = "https://www.google.com/recaptcha/api.js?render=explicit";
      s.async = true;
      s.defer = true;
      document.head.appendChild(s);
    }
  })();
</script>

<script>
  var RECAPTCHA_SITE_KEY = "6LfqOqAUAAAAANrSJEIFBRfy3WNIYfNMlV995CiY";
  var recaptchaWidgetId = null;

  // Sets Class5 from the selected option, then shows the reCAPTCHA
  function onLocationChange() {
    var select = document.getElementById("LinkCode");
    var opt = select.options[select.selectedIndex];
    document.querySelector("input[name='txtClass5']").value =
      (opt && opt.getAttribute("data-class5")) || "0";

    var container = document.getElementById("recaptcha-container");
    if (select.value !== "") {
      container.style.display = "block";
      renderRecaptcha();
    } else {
      container.style.display = "none";
    }
  }

  // Draws the reCAPTCHA once; waits for Google's script if it isn't ready yet
  function renderRecaptcha() {
    if (recaptchaWidgetId !== null) return;
    if (typeof grecaptcha === "undefined" || typeof grecaptcha.render !== "function") {
      setTimeout(renderRecaptcha, 200);
      return;
    }
    recaptchaWidgetId = grecaptcha.render("fbc-recaptcha", { sitekey: RECAPTCHA_SITE_KEY });
  }

  function validateRecaptcha(event) {
    var response = (recaptchaWidgetId !== null) ? grecaptcha.getResponse(recaptchaWidgetId) : "";
    if (response.length === 0) {
      event.preventDefault();
      alert("Please check the reCAPTCHA box before submitting.");
      return false;
    }
    return true;
  }
</script>

</body>
</html>
