X-Git-Url: http://git.hcoop.net/clinton/MarylandElectronicPetitionSignature.git/blobdiff_plain/7d59e09c615d0dad575734c97073ebac4f2850f0..50b6caaf7bdd577b1d234a8974060f67c926cc06:/enter_information.php diff --git a/enter_information.php b/enter_information.php index dec38d8..244d11d 100644 --- a/enter_information.php +++ b/enter_information.php @@ -76,75 +76,82 @@ slack_general('Enter Information ('.$_COOKIE['invite'].')','md-petition');
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E-Mail for Follow Up


(not required)
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E-Mail for Follow Up*

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First Name

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Last Name

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Date of Birth

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Phone Number

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Date of Birth Format

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MM DD YYYY

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Phone Number**

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Phone Format

443-123-4567

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House Number

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Building Number

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House Format

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321

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House: 321 Here St.

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Use: 321

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Apartment: 21 Here St. Apt 1323

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Use: 21

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ZIP Code

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ZIP Code Format

55555

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* E-Mail is not required, and will only be used internally, if we need to reach you. It will never sold or given out.
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** PHONE NUMBER IS REQUIRED BY STATE OF MARYLAND. WE WILL NEVER USE YOUR PHONE NUMBER - NEVER CALL - NEVER FOR TEXT MESSAGES.
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