What is JotForm?
JotForm is a free online form builder which helps you create online forms without writing a single line of code. No sign-up required.
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I have reactivated your account, but I have deleted the said fields. Please refrain from adding them again. Now, if you want to collect those, considering that your clients will agree to it, I would suggest doing it by either calling them or asking them to submit it through direct email.
Thank you for your kind understanding on this matter.