Pressbox is a locker-based dry cleaning, laundry, and shoe care service that operates in DC and Chicago. Once our lockers are installed at a property, residents use our app to order, track and pay for their order. To help us place our lockers in more buildings, we need to build a dynamic web form on our Square Space page that captures traffic from an advertising/PR campaign and encourages visitors to request that our service be installed at their apartment building.
There are two main elements and a third nice-to-have feature. We need this funnel to start with a 1) LOCATION SEARCH, which logs every address entry on a spreadsheet, then pushes the visitor to 2) a LOCATION REQUEST FORM if their entry is not one of our current locations. The form should collect the visitors name, email, and building addres as required fields and their property manager email as an optional field. If the property manager email address is filled, we need pre-filled message box to appear (with text like "I live in the building and think Pressbox would be a great addition to our community"). They should have to option to include the message or just request the location without a message. Ideally, 3) these MESSAGES SHOULD SEND AUTOMATICALLY TO PM, but we could always send the messages ourselves if all the info gets entered on a spreadsheet.
Kissmetric's site has the flow that we want, but of course the initial "Your Website URL" would be replaced with "Your Building Address" and the "Try Kissmetrics" button would read "Use Pressbox". If we already service the building they search for, we would push the visitor to our account creation page.
One last note; we currently use Storemapper, which can record the IP location and address entry for every search for an additional fee. I would prefer a simpler interface like Kissmetric's, but it might save time to use Storemapper to take care of requirement 1.
I have attached a (very crude) map of the flow/logic of this funnel.