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Form analysis
1 forms found in the DOM

POST /review/leave-feedback/64091/71c7425a3545072d78860618f203729552e040e4

<form class="content-form" action="/review/leave-feedback/64091/71c7425a3545072d78860618f203729552e040e4" method="post" novalidate="">
  <div class="spaced-content question-wrapper" data-selected-value="">
    <input type="hidden" name="questions[score]" required="">
    <div class="question-divider">
      <h5 class="size-5 question-index highlight-when-error" style="display: none;"> Question 1/1 <span class="error-message">(Please select a rating)</span></h5>
    </div>
    <label class="label"> How likely is it that you would recommend our company to a friend or colleague? </label>
    <div class="ratings-box ">
      <div class="row">
        <div class="item" data-value="0">0</div>
        <div class="item" data-value="1">1</div>
        <div class="item" data-value="2">2</div>
        <div class="item" data-value="3">3</div>
        <div class="item" data-value="4">4</div>
        <div class="item" data-value="5">5</div>
      </div>
      <div class="row">
        <div class="item" data-value="6">6</div>
        <div class="item" data-value="7">7</div>
        <div class="item" data-value="8">8</div>
        <div class="item" data-value="9">9</div>
        <div class="item" data-value="10">10</div>
      </div>
      <div class="row">
        <div class="is-pulled-left"> 0 = Not likely </div>
        <div class="is-pulled-right"> 10 = Very likely </div>
      </div>
    </div>
  </div>
  <div class="spaced-content">
    <h5 class="size-5 question-index highlight-when-error">Contact Information:</h5>
    <div class="question-wrapper">
      <div class="field">
        <label class="label"><span class="highlight-when-error">First Name* <span class="error-message"> (Please provide first name)</span>
          </span>
          <span class="tooltip-wrapper"> ? <span class="tooltip">
              <p class="has-text-weight-bold">Why do we ask?</p>
              <p>First Name is collected for the customer record of feedback and if the business owner shares your feedback and rating on their website. It’s displayed with your first name and last initial.</p>
            </span>
          </span>
        </label>
        <div class="control">
          <input class="input" type="text" name="firstName" required="" value="">
        </div>
      </div>
    </div>
    <div class="question-wrapper">
      <div class="field">
        <label class="label">
          <span class="highlight-when-error">Last Name* <span class="error-message"> (Please provide last name)</span>
          </span>
          <span class="tooltip-wrapper"> ? <span class="tooltip">
              <p class="has-text-weight-bold">Why do we ask?</p>
              <p>Last name is collected for the customer record of feedback and if the business owner shares your feedback and rating on their website. It’s displayed with your first name and last initial.</p>
            </span>
          </span>
        </label>
        <div class="control">
          <input class="input" type="text" name="lastName" id="lastName" required="" value="">
        </div>
      </div>
    </div>
    <div class="question-wrapper">
      <div class="field">
        <label class="label">
          <span class="highlight-when-error">Email* <span class="error-message"> (Email seems to be incorrect)</span>
          </span>
          <span class="tooltip-wrapper"> ? <span class="tooltip">
              <p class="has-text-weight-bold">Why do we ask?</p>
              <p>Your email address is collected for the customer record and to follow-up with you.</p>
            </span>
          </span>
        </label>
        <div class="control">
          <input class="input" type="text" name="email" id="email" required="" value="">
        </div>
      </div>
    </div>
  </div>
  <div class="spaced-content">
    <button type="submit" class="button is-rounded is-large is-primary give-feedback-button">Send Feedback</button>
  </div>
</form>

Text Content

Thank you for taking a moment to provide feedback on your recent experience with
Estes. Our goal is to always deliver a world-class customer experience, so it is
important to know how we are doing. Simply select a number below to rate our
service. Thanks again!

QUESTION 1/1 (PLEASE SELECT A RATING)

How likely is it that you would recommend our company to a friend or colleague?
0
1
2
3
4
5
6
7
8
9
10
0 = Not likely
10 = Very likely

CONTACT INFORMATION:

First Name* (Please provide first name) ?

Why do we ask?

First Name is collected for the customer record of feedback and if the business
owner shares your feedback and rating on their website. It’s displayed with your
first name and last initial.


Last Name* (Please provide last name) ?

Why do we ask?

Last name is collected for the customer record of feedback and if the business
owner shares your feedback and rating on their website. It’s displayed with your
first name and last initial.


Email* (Email seems to be incorrect) ?

Why do we ask?

Your email address is collected for the customer record and to follow-up with
you.


Send Feedback


By submitting this feedback, I understand and agree to the Review and Mobile
Marketing Policy.

*Your email address will not be shared or publicly visible.

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