Use this when

A prospect or customer wants your business to respond, quote, schedule, or follow up.

Then

Review the lead, assign an owner, and convert qualified requests into intake, quote, or booking records.

Review before sharing

Check names, dates, totals, and scope. Use a secure system for sensitive details that do not belong in a simple form.

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Your business

Contact & Lead Capture Form

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CONTACT & LEAD CAPTURE FORM
Document version 1.0.0


Created with FreeBusinessForms.com

Prompt for AI

Ask AI for a custom lead capture.

Copy into ChatGPT, Claude, or another assistant for a fillable version.

You are an experienced sales-operations document designer for small businesses.

Create a contact and lead-capture form for website inquiries, quote requests, partnership asks, and callbacks. It should collect enough to assign an owner and follow up—without becoming a survey or a payment form.

Include these sections:
- Business receiving the lead ([Your business name])
- Lead identity ([Lead or contact name], [Company name], [Email], [Phone])
- Source and request ([Lead source], [Request type], [Message], [Priority])
- Ownership ([Assigned to], [Next follow-up date], [Qualified? Yes / Not yet / No])
- Conversion note ([Next record: intake, quote, or booking])

Do not include Social Security numbers, full bank or payment-card numbers, routing numbers, passwords, tax ID numbers, medical details, identity documents, or protected-class information. This is an operational template, not legal, tax, accounting, payroll, collections, or employment advice.

Output a clean fillable template I can copy into a document and adapt. Use a professional tone, clearly labeled sections, and [bracketed] placeholders for every fill-in value. Close with a short practical review checklist.

Recommended books

Books for this form

Practical books that pair with this document. Links use our Amazon Associates ID.

Fanatical Prospecting

Jeb Blount

Treats every inbound lead as a follow-up job, not a contact that sits in a form.

View Fanatical Prospecting on Amazon

The 1-Page Marketing Plan

Allan Dib

Helps you define which requests this form is actually for.

View The 1-Page Marketing Plan on Amazon

They Ask, You Answer

Marcus Sheridan

A reminder that the message field is where buyers tell you the question you should answer next.

View They Ask, You Answer on Amazon

Machine access

JSON Schema

Agents can inspect and validate the same versioned fields. View JSON Schema →

Inspect JSON Schema

{
  "$schema": "https://json-schema.org/draft/2020-12/schema",
  "$id": "https://freebusinessforms.com/schemas/contact-lead-capture-form.json",
  "title": "Contact & Lead Capture Form",
  "description": "Collect website inquiries, sales leads, partnership requests, and callback details in one structured record.",
  "type": "object",
  "additionalProperties": false,
  "properties": {
    "business_name": {
      "title": "Your business name",
      "type": "string"
    },
    "lead_name": {
      "title": "Lead or contact name",
      "type": "string"
    },
    "company_name": {
      "title": "Company name",
      "type": "string"
    },
    "email": {
      "title": "Email",
      "type": "string",
      "format": "email"
    },
    "phone": {
      "title": "Phone",
      "type": "string"
    },
    "lead_source": {
      "title": "Lead source",
      "type": "string",
      "enum": [
        "Website",
        "Referral",
        "Search",
        "Social media",
        "Event",
        "Other"
      ]
    },
    "request_type": {
      "title": "Request type",
      "type": "string",
      "enum": [
        "General question",
        "Quote request",
        "Schedule a call",
        "Partnership",
        "Support",
        "Other"
      ]
    },
    "message": {
      "title": "Message",
      "type": "string"
    },
    "priority": {
      "title": "Priority",
      "type": "string",
      "enum": [
        "Normal",
        "High",
        "Urgent"
      ]
    },
    "assigned_to": {
      "title": "Assigned to",
      "type": "string"
    },
    "next_followup_date": {
      "title": "Next follow-up date",
      "type": "string",
      "format": "date"
    }
  },
  "required": [
    "business_name",
    "lead_name",
    "email",
    "message"
  ],
  "x-form-version": "1.0.0"
}