Ready-to-use Sign Up form

If you offer services on your website then most likely you need a "Sign Up" form.

The form is completely customizable!
JavaScript validates required fields; plus there is a verification on the server-side.
Captcha image protects the form against SPAM.
Captcha image can be reloaded.
There are many styles of Captcha image available.

How to use free BasicCaptcha code

1. Copy and paste the code below into your webpage.

2. Change the email address your@email.com to your own email address.

3. Change the return address http://www.YourWebsiteAddress.com/ThankYouPage.htm to your website address.

4. You can also change the email subject - Sign Up Web Form.

Warning: BasicCaptcha image has a link pointing to our site and promoting us; you must not remove the link, otherwise your site will be automatically banned in few days without warning. Do not add nofollow attribute!
If you don't like having a link then consider using our ProCaptcha form instead - click here.

<h2>Sign Up</h2>
<form action="https://www.SnapHost.com/captcha/send.aspx" id="ContactUsCaptchaWebForm" method="post" onsubmit="return ValidateForm(this);" target="_top">
<input id="skip_WhereToSend" name="skip_WhereToSend" type="hidden" value="your@email.com" />
<input id="skip_SnapHostID" name="skip_SnapHostID" type="hidden" value="ULFTTFJX5AP4" />
<input id="skip_WhereToReturn" name="skip_WhereToReturn" type="hidden" value="http://www.YourWebsiteAddress.com/ThankYouPage.htm" />
<input id="skip_Subject" name="skip_Subject" type="hidden" value="Sign Up Web Form" />
<input id="skip_ShowUsersIp" name="skip_ShowUsersIp" type="hidden" value="1" />
<input id="skip_SendCopyToUser" name="skip_SendCopyToUser" type="hidden" value="1" />
<script type="text/javascript">
function ValidateForm(frm) {
if (frm.FirstName.value == "") {alert('First Name is required.');frm.FirstName.focus();return false;}
if (frm.LastName.value == "") {alert('Last Name is required.');frm.LastName.focus();return false;}
if (frm.Organization.value == "") {alert('Organization is required.');frm.Organization.focus();return false;}
if (frm.FromEmailAddress.value == "") {alert('Email address is required.');frm.FromEmailAddress.focus();return false;}
if (frm.FromEmailAddress.value.indexOf("@") < 1 || frm.FromEmailAddress.value.indexOf(".") < 1) {alert('Please enter a valid email address.');frm.FromEmailAddress.focus();return false;}
if (frm.StreetAddress1.value == "") {alert('Address is required.');frm.StreetAddress1.focus();return false;}
if (frm.City.value == "") {alert('City is required.');frm.City.focus();return false;}
if (frm.Country.value == "") {alert('Country is required.');frm.Country.focus();return false;}
if (frm.skip_CaptchaCode.value == "") {alert('Enter web form code.');frm.skip_CaptchaCode.focus();return false;}
return true; }
function ReloadCaptchaImage(captchaImageId) {
var obj = document.getElementById(captchaImageId);
var src = '' + obj.src;
obj.src = '';
var date = new Date();
var pos = src.indexOf('&rad=');
if (pos >= 0) { src = src.substr(0, pos); }
obj.src = src + '&rad=' + date.getTime();
return false; }
</script>
<table border="0" cellpadding="5" cellspacing="0" width="600">
<tr>
<td><b>First, Last Name*:</b></td>
<td>
<input id="FirstName" name="FirstName" type="text" maxlength="60" style="width:146px; border:1px solid #999999" />
<input id="LastName" name="LastName" type="text" maxlength="60" style="width:146px; border:1px solid #999999" />
</td>
</tr><tr>
<td><b>Organization*:</b></td>
<td><input id="Organization" name="Organization" type="text" maxlength="60" style="width:300px; border:1px solid #999999" /></td>
</tr><tr>
<td><b>Email address*:</b></td>
<td><input id="FromEmailAddress" name="FromEmailAddress" type="text" maxlength="60" style="width:300px; border:1px solid #999999" /></td>
</tr><tr>
<td><b>Work Phone:</b></td>
<td><input id="WorkPhone" name="WorkPhone" type="text" maxlength="43" style="width:250px; border:1px solid #999999" /></td>
</tr><tr>
<td><b>Home Phone:</b></td>
<td><input id="HomePhone" name="HomePhone" type="text" maxlength="43" style="width:250px; border:1px solid #999999" /></td>
</tr><tr>
<td><b>Cell Phone:</b></td>
<td><input id="CellPhone" name="CellPhone" type="text" maxlength="43" style="width:250px; border:1px solid #999999" /></td>
</tr><tr>
<td><b>Fax:</b></td>
<td><input id="Fax" name="Fax" type="text" maxlength="43" style="width:250px; border:1px solid #999999" /></td>
</tr><tr>
<td><b>Address 1*:</b></td>
<td><input id="StreetAddress1" name="StreetAddress1" type="text" maxlength="120" style="width:350px; border:1px solid #999999" /></td>
</tr><tr>
<td><b>Address 2:</b></td>
<td><input id="StreetAddress2" name="StreetAddress2" type="text" maxlength="120" style="width:350px; border:1px solid #999999" /></td>
</tr><tr>
<td><b>City*:</b></td>
<td><input id="City" name="City" type="text" maxlength="120" style="width:300px; border:1px solid #999999" /></td>
</tr><tr>
<td><b>State/Province:</b></td>
<td><input id="State" name="State" type="text" maxlength="120" style="width:300px; border:1px solid #999999" /></td>
</tr><tr>
<td><b>Zip/Postal Code:</b></td>
<td><input id="Zip" name="Zip" type="text" maxlength="30" style="width:100px; border:1px solid #999999" /></td>
</tr><tr>
<td><b>Country*:</b></td>
<td><input id="Country" name="Country" type="text" maxlength="120" style="width:300px; border:1px solid #999999" /></td>
</tr><tr>
<td colspan="2" align="center">
<br />
<table border="0" cellpadding="0" cellspacing="0">
<tr><td colspan="2" style="padding-bottom:18px;">

<a href="http://www.snaphost.com/captcha/captchaguestbook.aspx" alt="web page guestbook" title="web page guestbook"
style="text-decoration:none; font-size:11px; font-family:Verdana, Arial, Helvetica; color:#000099;">
This web form is protected from SPAM by
<span style="text-decoration:underline;">SnapHost.com</span></a></td></tr>
<tr valign="top">
<td>
<i>Enter web form code*:</i>
<input id="skip_CaptchaCode" name="skip_CaptchaCode" type="text" style="width:80px; border:1px solid #999999" maxlength="6" />
</td><td>
<a href="http://www.snaphost.com/captcha/"><img id="CaptchaImage" alt="website email form" title="website email form"
style="margin-left:20px; border:1px solid #999999"
src="https://www.SnapHost.com/captcha/CaptchaImage.aspx?id=ULFTTFJX5AP4&ImgType=2" /></a>
<br /><a href="#" onclick="return ReloadCaptchaImage('CaptchaImage');"><span style="font-size:12px;">reload image</span></a>
</td>
</tr>
</table>
<br />
* - required fields.              
<input id="skip_Submit" name="skip_Submit" type="submit" value="Submit" />
</td>
</tr>
</table>
<br />
</form>

HTML code for "Sign Up" form

How to use free BasicCaptcha code