Is it possible to use full html forms on Jotform

  • Profile Image
    MattCobb
    Asked on January 29, 2013 at 09:55 PM

    I.E I already have a form (Below) that i would like to use as I have no backend script access

     

          Full Name:       

          <input type=text name="Applicant First Name" size=15> <input type=text name="Applicant Middle Initial" size=2> <input type=text name="Applicant Last Name" size=29><br>

          Mailing Address:

          <input type=text name="Applicant Mailing Address" size=55><br>

          City:

          <input type=text name=City size=33>

            <b>VIRGINIA</b><br>

          Zip Code:

          <input type=text name="Zip Code" size=11><br>

          Email Address: <b>(Required)</b> 

          <input type=text name="Applicant Email Address" size=44><br>

          Home Phone:

          <input type=text name="Applicant Home Phone" size=12> 

          Work Phone:

          <input type=text name="Applicant Work Phone" size=12> 

          Ext.

          <input type=text name="Extension Number" size=5><br>

          How to Contact You:

          <select name="Contact Me" size="1">

          <option selected>Select One

          <option>Phone at Work

          <option>Phone at Home

          <option>Email

          </select><br>

          Current Insurance Company: <input type=text name="Current Insurance Co" size=35><br>

          Expiration Date: <input type=text name="Insurance Expiration" size=15>(mm/dd/yyyy)<br>

          <br>

          <b>Virginia Auto Insurance Coverage Information:</b><br>

          <br>

          <b>Vehicle</b>     <b>Year</b>             <b>Make</b>                <b>Model</b>                <b>Body Type</b>

          <br>

               <b>1</b>      

          <input type=text name="auto1 Year" size=6> <input type=text name="auto1 Make" size=12>

          <input type=text name="auto1 Model" size=15>

          <select name="auto1 Body Type" size=1>

          <option selected value="Select One">Select One

          <option value=4door>Four Door Sedan

          <option value=2door>Two Door Coupe

          <option value="Sports Car">Sports Car

          <option value="Luxury Sedan">Luxury Sedan

          <option value="Sports Utility">Sports Utility

          <option value="Wagon Minivan">Wagon-Minivan

          <option value="Pickup Truck">Pickup Truck

          </select><br>

               <b>2</b>      

          <input type=text name="auto2 Year" size=6> <input type=text name="auto2 Make" size=12>

          <input type=text name="auto2 Model" size=15>

          <select name="auto2 Body Type" size=1>

          <option selected value="Select One">Select One

          <option value=4door>Four Door Sedan

          <option value=2door>Two Door Coupe

          <option value="Sports Car">Sports Car

          <option value="Luxury Sedan">Luxury Sedan

          <option value="Sports Utility">Sports Utility

          <option value="Wagon Minivan">Wagon-Minivan

          <option value="Pickup Truck">Pickup Truck

          </select><br>

               <b>3</b>      

          <input type=text name="auto3 Year" size=6> <input type=text name="auto3 Make" size=12>

          <input type=text name="auto3 Model" size=15>

          <select name="auto3 Body Type" size=1>

          <option selected value="Select One">Select One

          <option value=4door>Four Door Sedan

          <option value=2door>Two Door Coupe

          <option value="Sports Car">Sports Car

          <option value="Luxury Sedan">Luxury Sedan

          <option value="Sports Utility">Sports Utility

          <option value="Wagon Minivan">Wagon-Minivan

          <option value="Pickup Truck">Pickup Truck

          </select><br>

          <br>

          <b>Pickup Truck Information (if applicable):</b><br>

          Does your truck have a cap?

          <select name="truck cap" size=1>

          <option selected value="Select One">Select

          <option value=No>No

          <option value=Yes>Yes

          </select><br>

          If Yes, what is its value: $<input type=text name="truck cap value $" size=4><br>

          Does your truck have a snow plow?

          <select name="truck snow plow" size=1>

          <option selected value="Select One">Select

          <option value=No>No

          <option value=Yes>Yes

          </select><br>

          If Yes, what is its value: $<input type=text name="truck snow plow value $" size=4><br>

          <br>

          <b>Vehicle</b>     <b>Primary Use</b>     <b>Miles Driven to Work</b><br>

               <b>1</b>       

          <select name="auto1 Primary Use" size=1>

          <option selected value="Select One">Select One

          <option value=Pleasure>Pleasure

          <option value=Commute>Commute

          <option value=Business>Business

          <option value=Government>Government

          <option value="Farm Use">Farm Use

          </select>       

          <select name="auto1 Miles Driven" size=1>

          <option selected value="Select One">Select One

          <option value=None>None

          <option value="Under 3 Miles">Under 3 Miles

          <option value="3-10 Miles">3-10 Miles

          <option value="10-20 Miles">10-20 Miles

          <option value="Over 20 Miles">Over 20 Miles

          </select><br>

               <b>2</b>       

          <select name="auto2 Primary Use" size=1>

          <option selected value="Select One">Select One

          <option value=Pleasure>Pleasure

          <option value=Commute>Commute

          <option value=Business>Business

          <option value=Government>Government

          <option value="Farm Use">Farm Use

          </select>       

          <select name="auto2 Miles Driven" size=1>

          <option selected value="Select One">Select One

          <option value=None>None

          <option value="Under 3 Miles">Under 3 Miles

          <option value="3-10 Miles">3-10 Miles

          <option value="10-20 Miles">10-20 Miles

          <option value="Over 20 Miles">Over 20 Miles

          </select><br>

               <b>3</b>       

          <select name="auto3 Primary Use" size=1>

          <option selected value="Select One">Select One

          <option value=Pleasure>Pleasure

          <option value=Commute>Commute

          <option value=Business>Business

          <option value=Government>Government

          <option value="Farm Use">Farm Use

          </select>       

          <select name="auto3 Miles Driven" size=1>

          <option selected value="Select One">Select One

          <option value=None>None

          <option value="Under 3 Miles">Under 3 Miles

          <option value="3-10 Miles">3-10 Miles

          <option value="10-20 Miles">10-20 Miles

          <option value="Over 20 Miles">Over 20 Miles

          </select><br>

          <br>

          <b>Additonal Auto Insurance Information:</b><br>

          <br>

                                                                     <b>Where</b>          <b>Lienholder</b>        <b>Lienholder</b><br>

          <b>Vehicle</b>              <b>VIN#</b>                      <b>Garaged</b>          <b>Yes/No</b>               <b>Name</b><br>

               <b>1</b>      

          <input type=text name="auto1 VIN" size=20> <input type=text name="auto1 Garaged" size=15>

          <select name="auto1 Lienholder" size=1>

          <option selected value="Select One">Select

          <option value=No>No

          <option value=Yes>Yes

          </select> <input type=text name="auto1 Lienholder Name" size=17><br>

               <b>2</b>      

          <input type=text name="auto2 VIN" size=20> <input type=text name="auto2 Garaged" size=15>

          <select name="auto2 Lienholder" size=1>

          <option selected value="Select One">Select

          <option value=No>No

          <option value=Yes>Yes

          </select> <input type=text name="auto2 Lienholder Name" size=17><br>

               <b>3</b>      

          <input type=text name="auto3 VIN" size=20> <input type=text name="auto3 Garaged" size=15>

          <select name="auto3 Lienholder" size=1>

          <option selected value="Select One">Select

          <option value=No>No

          <option value=Yes>Yes

          </select> <input type=text name="auto3 Lienholder Name" size=17><br>

          <br>

          <b>Virginia Auto Insurance Coverage Information:</b><br>

          <br>

                                <b>Liability</b>                 <b>Property</b>                   <b>Uninsured</b><br>

          <b>Vehicle</b>    <b>Limits(x $1,000)</b>          <b>Damage</b>             <b>Motorist(x $1,000)</b>       <b>Medical</b><br>

               <b>1</b>       

          <select name="auto1 liability" size=1>

          <option selected value="Select One">Select One

          <option value=25:50>25/50

          <option value=30:60>30/60

          <option value=50:100>50/100

          <option value=100:300>100/300

          <option value=250:500>250/500

          </select>           

          <select name="auto1 Property Damage" size=1>

          <option selected value="Select One">Select One

          <option value=$20,000>$20,000

          <option value=$25,000>$25,000

          <option value=$50,000>$50,000

          <option value=$100,000>$100,000

          </select>           

          <select name="auto1 Uninsured" size=1>

          <option selected value="Select One">Select One

          <option value=25:50>25/50

          <option value=30:60>30/60

          <option value=50:100>50/100

          <option value=100:300>100/300

          <option value=250:500>250/500

          </select>        

          <select name="auto1 Medical" size=1>

          <option selected value="Select One">Select One

          <option value=$5000>$5,000

          <option value=$10000>$10,000

          <option value=$25000>$25,000

          </select><br>

               <b>2</b>            

          <b>SAME</b>

          </select>                     

          <b>SAME</b>

          </select>                     

          <b>SAME</b>

          </select>                 

          <b>SAME</b><br>

               <b>3</b>            

          <b>SAME</b>

          </select>                     

          <b>SAME</b>

          </select>                     

          <b>SAME</b>

          </select>                 

          <b>SAME</b><br>

          <br>

          <br>

                             <b>Collision</b>         <b>Comprehensive</b><br>

          <b>Vehicle</b>    <b>Deductible</b>           <b>Deductible</b><br>

               <b>1</b>       

          <select name="auto1 Collision Deductible" size=1>

          <option selected value="Select One">Select One

          <option value=None>None

          <option value=$250>$250

          <option value=$500>$500

          <option value=$1000>$1000

          </select>     

          <select name="auto1 Comprehensive Deductible" size=1>

          <option selected value="Select One">Select One

          <option value=None>None

          <option value=$250>$250

          <option value=$500>$500

          <option value=$1000>$1,000

          </select><br>

               <b>2</b>       

          <select name="auto2 Collision Deductible" size=1>

          <option selected value="Select One">Select One

          <option value=None>None

          <option value=$250>$250

          <option value=$500>$500

          <option value=$1000>$1000

          </select>     

          <select name="auto2 Comprehensive Deductible" size=1>

          <option selected value="Select One">Select One

          <option value=None>None

          <option value=$250>$250

          <option value=$500>$500

          <option value=$1000>$1,000

          </select><br>

               <b>3</b>       

          <select name="auto3 Collision Deductible" size=1>

          <option selected value="Select One">Select One

          <option value=None>None

          <option value=$250>$250

          <option value=$500>$500

          <option value=$1000>$1000

          </select>     

          <select name="auto3 Comprehensive Deductible" size=1>

          <option selected value="Select One">Select One

          <option value=None>None

          <option value=$250>$250

          <option value=$500>$500

          <option value=$1000>$1,000

          </select><br>

          <br>

          <b>Endorsements</b><br>

          <b>Vehicle</b>      <b>Towing</b>                   <b>Rental</b><br>

               <b>1</b>       

          <select name="auto1 Towing" size=1>

          <option selected value="Select One">Select One

          <option value=None>None

          <option value=$25>$25

          <option value=$50>$50

          <option value=$75>$75

          </select>      

          <select name="auto1 Rental" size=1>

          <option selected value="Select One">Select One

          <option value=None>None

          <option value=$15>$15

          <option value=$30>$30

          </select><br>

               <b>2</b>       

          <select name="auto2 Towing" size=1>

          <option selected value="Select One">Select One

          <option value=None>None

          <option value=$25>$25

          <option value=$50>$50

          <option value=$75>$75

          </select>      

          <select name="auto2 Rental" size=1>

          <option selected value="Select One">Select One

          <option value=None>None

          <option value=$15>$15

          <option value=$30>$30

          </select><br>

               <b>3</b>       

          <select name="auto3 Towing" size=1>

          <option selected value="Select One">Select One

          <option value=None>None

          <option value=$25>$25

          <option value=$50>$50

          <option value=$75>$75

          </select>      

          <select name="auto3 Rental" size=1>

          <option selected value="Select One">Select One

          <option value=None>None

          <option value=$15>$15

          <option value=$30>$30

          </select><br>

          <br>

          <b>Virginia Driver Information:</b><br>

          <br>

                                            <b>Drivers </b>                    <b>Date of</b><br>

          <b>Driver</b>                       <b>Name</b>                          <b>Birth</b>                  <b>Gender</b><br>

               <b>1</b>          

          <input type=text name="auto1 Driver Name" size=25>  

          <input type=text name="auto1 Driver Birthday" size=12>  

          <select name="auto1 Driver Gender" size=1>

          <option selected value="Select One">Select One

          <option value=Female>Female

          <option value=Male>Male

          </select><br>

               <b>2</b>          

          <input type=text name="auto2 Driver Name" size=25>  

          <input type=text name="auto2 Driver Birthday" size=12>  

          <select name="auto2 Driver Gender" size=1>

          <option selected value="Select One">Select One

          <option value=Female>Female

          <option value=Male>Male

          </select><br>

               <b>3</b>          

          <input type=text name="auto3 Driver Name" size=25>  

          <input type=text name="auto3 Driver Birthday" size=12>  

          <select name="auto3 Gender" size=1>

          <option selected value="Select One">Select One

          <option value=Female>Female

          <option value=Male>Male

          </select><br>

          <br>

                                            <b>Drivers </b>                 <b>How Long</b>          <b>Marital</b><br>

          <b>Driver</b> &bbsp;                  <b>Occupation</b>                <b>Licensed</b>            <b>Status</b><br>

               <b>1</b>          

          <input type=text name="auto1 Driver Occupation" size=25>  

          <input type=text name="auto1 Driver How long licensed" size=8>  

          <select name="auto1 Driver Marital Status" size=1>

          <option selected value="Select One">Select One

          <option value=Married>Married

          <option value=Single>Single

          <option value="Single with child">Single with Child

          </select><br>

               <b>2</b>          

          <input type=text name="auto2 Driver Occupation" size=25>  

          <input type=text name="auto2 Driver How long licensed" size=8>  

          <select name="auto2 Driver Marital Status" size=1>

          <option selected value="Select One">Select One

          <option value=Married>Married

          <option value=Single>Single

          <option value="Single with child">Single with Child

          </select><br>

               <b>3</b>          

          <input type=text name="auto3 Driver Occupation" size=25>  

          <input type=text name="auto3 Driver How long licensed" size=8>  

          <select name="auto3 Driver Marital Status" size=1>

          <option selected value="Select One">Select One

          <option value=Married>Married

          <option value=Single>Single

          <option value="Single with child">Single with Child

          </select><br>

          <br>

          <b>Is your driving record accident & violation free during the past 5 years?</b><br>

          <b>Driver</b><br>

               <b>1</b>      

          <select name="auto1 Accident Free?" size=1>

          <option selected value="Select">Select

          <option value=No>No

          <option value=Yes>Yes

          </select> 

          If No, how many accidents? <input type=text name="auto1 Accident#" size=2>  

          How many violations? <input type=text name="auto1 Violation#" size=2><br>

               <b>2</b>      

          <select name="auto2 Accident Free?" size=1>

          <option selected value="Select">Select

          <option value=No>No

          <option value=Yes>Yes

          </select> 

          If No, how many accidents? <input type=text name="auto2 Accident#" size=2>  

          How many violations? <input type=text name="auto2 Violation#" size=2><br>

               <b>3</b>      

          <select name="auto3 Accident Free?" size=1>

          <option selected value="Select">Select

          <option value=No>No

          <option value=Yes>Yes

          </select> 

          If No, how many accidents? <input type=text name="auto3 Accident#" size=2>  

          How many violations? <input type=text name="auto3 Violation#" size=2><br>

          <br>

          <b>Was your driver's license suspended during the past 5 years?</b><br>

          <b>Driver</b><br>

               <b>1</b>      

          <select name="auto1 License Suspended?" size=1>

          <option selected value="Select">Select

          <option value=No>No

          <option value=Yes>Yes

          </select><br>

               <b>2</b>      

          <select name="auto2 License Suspended?" size=1>

          <option selected value="Select">Select

          <option value=No>No

          <option value=Yes>Yes

          </select><br>

               <b>3</b>      

          <select name="auto3 License Suspended?" size=1>

          <option selected value="Select">Select

          <option value=No>No

          <option value=Yes>Yes

          </select><br>

          <br>

          Additional Information or Comments<br>

          <input type=text name="Additional Information or Comments" size=52><br>

          <br>

          <b>Click on the "Submit Quote Information" button below to<br>

          send your Virginia Auto insurance quote request.**</b><br>

          <br>

          **Information received from this Virginia Auto Insurance quote request<br>

          form sent to Stover Insurance Agency will be for our use only and<br>

          will not be sold, given to, or distributed to any other parties. A quote will be<br>

          based on the auto insurance policy information provided and does not<br>

          guarantee acceptance of the risk by us. The precise coverage<br>

          afforded is subject to meeting underwriting guidelines, and the terms,<br>

          conditions and exclusions of the policy as issued. By submitting this<br>

          request you acknowledge that this is neither an offer to insure nor a<br>

          guarantee of insurance. Completion of this form does not entitle you to<br>

          a Virginia Auto Insurance policy. We are licensed in Virginia, Maryland,<br>

          and DC and will not provide auto insurance quotes for other states.<br>

          <br>

          <input type="submit" value="Submit Virginia Auto Insurance Quote Info"><br>

          </form>

  • Profile Image
    EltonCris
    Answered on January 29, 2013 at 11:51 PM

    Hi,

    Yes that's possible. We even allow downloading of form's full source code. Here's a guide for that: How to get your Form Source Code

    Feel free to let us know if you come across any issues with JotForm. Thanks!