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Plumber Service Request Form

When someone's basement is filling with water, they don't want a 'Contact Us' form — they want a Call Now button and a backup form that gets read in 60 seconds. Both, actually.

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form.htmlhtml43 lines

01<form action="https://splitforms.com/api/submit" method="POST">
02  <input type="hidden" name="access_key" value="YOUR_ACCESS_KEY">
03  <input type="hidden" name="subject" value="New plumbing request">
04 
05  <label for="name">Full name *</label>
06  <input id="name" type="text" name="name" placeholder="Daniel Chen" required>
07  <label for="email">Email *</label>
08  <input id="email" type="email" name="email" placeholder="daniel@example.com" required>
09  <label for="phone">Phone *</label>
10  <input id="phone" type="tel" name="phone" placeholder="+1 555 0142" required>
11  <label for="address">Service address *</label>
12  <input id="address" type="text" name="address" placeholder="1247 Valencia St, San Francisco" required>
13  <label for="urgency">How urgent? *</label>
14  <select id="urgency" name="urgency" required>
15    <option value="">Choose…</option>
16    <option>Emergency — water everywhere</option>
17    <option>Today if possible</option>
18    <option>This week</option>
19    <option>Just a quote for now</option>
20  </select>
21  <label for="service">Type of work *</label>
22  <select id="service" name="service" required>
23    <option value="">Choose…</option>
24    <option>Leaking pipe</option>
25    <option>Clogged drain</option>
26    <option>Water heater</option>
27    <option>Toilet repair</option>
28    <option>Faucet / fixture install</option>
29    <option>Bathroom remodel</option>
30    <option>Other</option>
31  </select>
32  <label for="details">Describe the issue *</label>
33  <textarea id="details" name="details" placeholder="When it started, what you've already tried…" required></textarea>
34 
35  <!-- honeypot — bots fill every field -->
36  <input type="checkbox" name="botcheck" style="display:none" tabindex="-1" autocomplete="off">
37 
38  <button type="submit">Send</button>
39</form>
40 
41<p style="margin-top:12px;font-size:11px;color:#888;text-align:right">
42  Powered by <a href="https://splitforms.com" style="color:#888;text-decoration:none" target="_blank" rel="noopener">splitforms</a>
43</p>

1,000

submissions / mo, free

fields, ready to ship

code outputs

60s

from copy to inbox

Plumber Service Request Form — example splitforms template with submissions inbox

§ 01Why it mattersthe qualifying-fields argument

Plumbing leads come in two shapes: emergency (active leak, no hot water, sewage backup — they need someone today, price barely matters) and scheduled (water heater swap, bathroom remodel rough-in, repipe — they're shopping three quotes). The form needs an urgency dropdown so dispatch can sort the queue, plus enough detail (issue, location in home, address) that the tech rolls with the right truck stock. Skip those fields and every call starts with 20 questions.

Webhook into ServiceTitan / Housecall Pro / Jobber via Zapier in 5 minutes.

✦ at a glance

→Plumbing service request · 7 fields
→HTML, JS, React, PHP, cURL outputs
→One POST endpoint, no SDK
→Honeypot + classifier, no CAPTCHA

§ 02Live previewinteractive · sandboxed · no key required

See exactly what your visitors see — and you’ll receive.

Left: the rendered form, fully interactive in a sandboxed iframe. Right: the email and dashboard view that lands the moment a visitor submits.

preview · plumber-contact-formlocalhost:3000

✦ what you’ll see in your inbox

Every submission becomes an email plus a dashboard row. The fields below are the exact payload your form will send. Reply-to is wired to the visitor’s email so hitting reply goes back to them.

dashboard · new submission14ms · 200 OK

SUBJECT · New plumbing request

Full name: Maya Iyer
Email: maya@studio71.co
Phone: +1 415 555 0142
Service address: —
How urgent?: Emergency — water everywhere
Type of work: Leaking pipe
Describe the issue: Loved your last open house in Hayes — looking for similar with parking. Pre-approved through Wells Fargo.

Iframe is sandboxed — submit doesn’t actually fire. Get your access key to wire it up live.

§ 03Three steps3 steps · ~60 seconds

Generate, embed, receive.

Three actions stand between you and your first lead. None of them require a backend, a database, or a CAPTCHA library.

STEP 01GENERATE

Add the form to your service pages

Each service page (drain cleaning, water heater, leak repair) gets the same form with a hidden 'service' field pre-filled. The submission tells you which page they came from.

Create your form

key=sk_live_••••••••

STEP 02EMBED

Sort by urgency

Dropdown options: 'Emergency — within 2 hrs', 'Today', 'This week', 'Just a quote'. Dispatch sorts the inbox by that field every morning.

snippethtml

<form action="https://splitforms.com/api/submit" method="POST">
  …
</form>

STEP 03RECEIVE

Forward to dispatch / phone

Webhook the submission to your dispatch software (ServiceTitan, Housecall Pro, Jobber) or to a Twilio SMS that pings the on-call tech's phone. Email backup goes to the office.

inbox · 1 newjust now

FROM contact@yoursite.com

New plumbing request

Maya Iyer maya@studio71.co

Loved your last open house in Hayes — looking for similar with parking. Pre-approved through Wells Fargo.

§ 04Copy & ship5 languages · same endpoint

Five outputs. One backend.

HTML by default. Click open the language you ship in — every variant POSTs to the same /api/submit endpoint.

01HTMLform.html43 lines

<form action="https://splitforms.com/api/submit" method="POST">
  <input type="hidden" name="access_key" value="YOUR_ACCESS_KEY">
  <input type="hidden" name="subject" value="New plumbing request">

  <label for="name">Full name *</label>
  <input id="name" type="text" name="name" placeholder="Daniel Chen" required>
  <label for="email">Email *</label>
  <input id="email" type="email" name="email" placeholder="daniel@example.com" required>
  <label for="phone">Phone *</label>
  <input id="phone" type="tel" name="phone" placeholder="+1 555 0142" required>
  <label for="address">Service address *</label>
  <input id="address" type="text" name="address" placeholder="1247 Valencia St, San Francisco" required>
  <label for="urgency">How urgent? *</label>
  <select id="urgency" name="urgency" required>
    <option value="">Choose…</option>
    <option>Emergency — water everywhere</option>
    <option>Today if possible</option>
    <option>This week</option>
    <option>Just a quote for now</option>
  </select>
  <label for="service">Type of work *</label>
  <select id="service" name="service" required>
    <option value="">Choose…</option>
    <option>Leaking pipe</option>
    <option>Clogged drain</option>
    <option>Water heater</option>
    <option>Toilet repair</option>
    <option>Faucet / fixture install</option>
    <option>Bathroom remodel</option>
    <option>Other</option>
  </select>
  <label for="details">Describe the issue *</label>
  <textarea id="details" name="details" placeholder="When it started, what you've already tried…" required></textarea>

  <!-- honeypot — bots fill every field -->
  <input type="checkbox" name="botcheck" style="display:none" tabindex="-1" autocomplete="off">

  <button type="submit">Send</button>
</form>

<p style="margin-top:12px;font-size:11px;color:#888;text-align:right">
  Powered by <a href="https://splitforms.com" style="color:#888;text-decoration:none" target="_blank" rel="noopener">splitforms</a>
</p>

02JavaScriptform.js59 lines

<form id="lf-form">
  <label for="name">Full name *</label>
  <input id="name" type="text" name="name" placeholder="Daniel Chen" required>
  <label for="email">Email *</label>
  <input id="email" type="email" name="email" placeholder="daniel@example.com" required>
  <label for="phone">Phone *</label>
  <input id="phone" type="tel" name="phone" placeholder="+1 555 0142" required>
  <label for="address">Service address *</label>
  <input id="address" type="text" name="address" placeholder="1247 Valencia St, San Francisco" required>
  <label for="urgency">How urgent? *</label>
  <select id="urgency" name="urgency" required>
    <option value="">Choose…</option>
    <option>Emergency — water everywhere</option>
    <option>Today if possible</option>
    <option>This week</option>
    <option>Just a quote for now</option>
  </select>
  <label for="service">Type of work *</label>
  <select id="service" name="service" required>
    <option value="">Choose…</option>
    <option>Leaking pipe</option>
    <option>Clogged drain</option>
    <option>Water heater</option>
    <option>Toilet repair</option>
    <option>Faucet / fixture install</option>
    <option>Bathroom remodel</option>
    <option>Other</option>
  </select>
  <label for="details">Describe the issue *</label>
  <textarea id="details" name="details" placeholder="When it started, what you've already tried…" required></textarea>
  <button type="submit">Send</button>
</form>

<p style="margin-top:12px;font-size:11px;color:#888;text-align:right">
  Powered by <a href="https://splitforms.com" style="color:#888;text-decoration:none" target="_blank" rel="noopener">splitforms</a>
</p>

<script>
  document.getElementById('lf-form').addEventListener('submit', async (e) => {
    e.preventDefault();
    const data = new FormData(e.target);
    data.set('access_key', 'YOUR_ACCESS_KEY');
    data.set('subject', 'New plumbing request');

    const res = await fetch('https://splitforms.com/api/submit', {
      method: 'POST',
      body: data,
      headers: { Accept: 'application/json' },
    });

    const json = await res.json();
    if (json.success) {
      e.target.reset();
      alert('Sent!');
    } else {
      alert('Error: ' + (json.message || 'Try again'));
    }
  });
</script>

03React / Next.jsForm.tsx74 lines

'use client';

import { useState, type FormEvent } from 'react';

export default function PlumberCalloutForm() {
  const [status, setStatus] = useState<'idle' | 'sending' | 'sent' | 'error'>('idle');

  async function onSubmit(e: FormEvent<HTMLFormElement>) {
    e.preventDefault();
    setStatus('sending');

    const data = new FormData(e.currentTarget);
    data.set('access_key', 'YOUR_ACCESS_KEY');
    data.set('subject', 'New plumbing request');

    const res = await fetch('https://splitforms.com/api/submit', {
      method: 'POST',
      body: data,
      headers: { Accept: 'application/json' },
    });

    const json = await res.json();
    setStatus(json.success ? 'sent' : 'error');
    if (json.success) e.currentTarget.reset();
  }

  if (status === 'sent') return <p>Thanks — we&rsquo;ll be in touch.</p>;

  return (
    <>
    <form onSubmit={onSubmit}>
      <label htmlFor="name">Full name *</label>
      <input id="name" type="text" name="name" placeholder="Daniel Chen" required />
      <label htmlFor="email">Email *</label>
      <input id="email" type="email" name="email" placeholder="daniel@example.com" required />
      <label htmlFor="phone">Phone *</label>
      <input id="phone" type="tel" name="phone" placeholder="+1 555 0142" required />
      <label htmlFor="address">Service address *</label>
      <input id="address" type="text" name="address" placeholder="1247 Valencia St, San Francisco" required />
      <label htmlFor="urgency">How urgent? *</label>
      <select id="urgency" name="urgency" required>
        <option value="">Choose…</option>
        <option>Emergency — water everywhere</option>
        <option>Today if possible</option>
        <option>This week</option>
        <option>Just a quote for now</option>
      </select>
      <label htmlFor="service">Type of work *</label>
      <select id="service" name="service" required>
        <option value="">Choose…</option>
        <option>Leaking pipe</option>
        <option>Clogged drain</option>
        <option>Water heater</option>
        <option>Toilet repair</option>
        <option>Faucet / fixture install</option>
        <option>Bathroom remodel</option>
        <option>Other</option>
      </select>
      <label htmlFor="details">Describe the issue *</label>
      <textarea id="details" name="details" placeholder="When it started, what you've already tried…" required />

      <button type="submit" disabled={status === 'sending'}>
        {status === 'sending' ? 'Sending…' : 'Send'}
      </button>

      {status === 'error' && <p>Something went wrong. Try again.</p>}
    </form>

      <p style={{ marginTop: 12, fontSize: 11, color: '#888', textAlign: 'right' }}>
        Powered by <a href="https://splitforms.com" target="_blank" rel="noopener" style={{ color: '#888', textDecoration: 'none' }}>splitforms</a>
      </p>
    </>
  );
}

04PHPsubmit.php28 lines

<?php
// Drop into a PHP page. Receives a form POST and proxies it to splitforms.com.
// Useful when you want to add server-side validation or rate limiting.

if ($_SERVER['REQUEST_METHOD'] === 'POST') {
    $allowed = ['name', 'email', 'phone', 'address', 'urgency', 'service', 'details'];
    $payload = ['access_key' => 'YOUR_ACCESS_KEY'];
    $payload['subject'] = 'New plumbing request';

    foreach ($allowed as $f) {
        if (isset($_POST[$f])) $payload[$f] = $_POST[$f];
    }

    $ch = curl_init('https://splitforms.com/api/submit');
    curl_setopt($ch, CURLOPT_POST, true);
    curl_setopt($ch, CURLOPT_POSTFIELDS, http_build_query($payload));
    curl_setopt($ch, CURLOPT_RETURNTRANSFER, true);
    curl_setopt($ch, CURLOPT_HTTPHEADER, ['Accept: application/json']);
    $response = curl_exec($ch);
    $status   = curl_getinfo($ch, CURLINFO_HTTP_CODE);
    curl_close($ch);

    header('Content-Type: application/json');
    http_response_code($status);
    echo $response;
    exit;
}
?>

05cURLtest.sh11 lines

curl -X POST https://splitforms.com/api/submit \
  -H "Accept: application/json" \
  -d "access_key=YOUR_ACCESS_KEY" \
  -d "subject=New plumbing request" \
  -d "name=Jane Builder" \
  -d "email=jane@example.com" \
  -d "phone=+15555555555" \
  -d "address=Jane Builder" \
  -d "urgency=Emergency — water everywhere" \
  -d "service=Leaking pipe" \
  -d "details=Hello from cURL"

Replace YOUR_ACCESS_KEY with the key from your dashboard. That’s the only edit.

§ 04bUse this template with…17 frameworks · same backend

One template. Every framework.

The same field set works on every framework splitforms supports. HTML, React, Next.js, Vue, Astro, Hugo, WordPress — same POST, same backend.

§ 06FAQ4 answered

Things people ask before they ship.

Direct answers, no marketing fluff. Missing one? Email hello@splitforms.com.

01Should I still have a phone number on the page?

Yes — make it the biggest button on the page. Phone converts at 5-10x form fill for emergency plumbing. The form is the backup for after-hours and for non-urgent quotes that don't need a 2am call.

02Can I send the lead straight to ServiceTitan or Housecall Pro?

Yes — splitforms webhooks the submission as JSON, and both platforms have webhook-receiving endpoints (or Zapier connectors). Lead lands in dispatch with the issue type and address pre-filled.

03How do I avoid spam from form-scraper bots?

Every form has a hidden honeypot and a server-side spam classifier. Plumbing forms get hit hard by SEO-spam bots — we automatically drop submissions with link-stuffed message bodies.

04Do customers really fill out forms for emergency plumbing?

After business hours, yes. During business hours, they call. Dual-pathway — phone CTA above the form, form below — captures both behaviours.

✻ ✻ ✻

Ship your plumber service request form in 60 seconds.

1,000 free submissions per month. No credit card. Copy the snippet, paste your access key, watch leads land in your inbox.

Get free access key →Browse all 60 templates →

v0.1 · founders pricing locked in · early access open