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Request4 fields

Callback Request

Let visitors request a callback at their preferred time.

Spam protectionEmail notificationsAI sales agentSubmission dashboardNo backend needed

Live Preview

Exactly what visitors will see on your site

Request a Callback

What you'll collect

Every field in this template, ready to use out of the box.

Full Name

text · required

Phone

tel · required

Best Time to Call

select · required

Regarding

textarea · required

Copy the Code

Choose HTML for static sites or React for component-based apps. Replace YOUR_FORM_ID with your Flowqen endpoint ID.

<form
  action="https://flowqen.com/api/f/YOUR_FORM_ID"
  method="POST"
  class="max-w-xl mx-auto rounded-[32px] border-2 border-[#231b17] bg-[#fffdf9] px-6 py-7 shadow-none sm:px-8"
>
  <h2 class="text-2xl font-semibold tracking-tight text-[#231b17] mb-6">Request a Callback</h2>


  <div class="space-y-4">
    <div>
      <label class="mb-1.5 block text-sm font-medium text-[#4f4138]">Full Name</label>
      <input type="text" name="full_name" class="w-full rounded-[18px] border border-[#d9cdc3] bg-white px-4 py-3 text-sm text-[#231b17] outline-none transition focus:border-[#231b17] focus:ring-4 focus:ring-[#231b17]/8" placeholder="Jane Doe" required />
    </div>


    <div>
      <label class="mb-1.5 block text-sm font-medium text-[#4f4138]">Phone</label>
      <input type="tel" name="phone" class="w-full rounded-[18px] border border-[#d9cdc3] bg-white px-4 py-3 text-sm text-[#231b17] outline-none transition focus:border-[#231b17] focus:ring-4 focus:ring-[#231b17]/8" placeholder="+1 (555) 000-0000" required />
    </div>


    <div>
      <label class="mb-1.5 block text-sm font-medium text-[#4f4138]">Best Time to Call</label>
      <select name="best_time" class="w-full rounded-[18px] border border-[#d9cdc3] bg-white px-4 py-3 text-sm text-[#231b17] outline-none transition focus:border-[#231b17] focus:ring-4 focus:ring-[#231b17]/8" required>
        <option value="">Select...</option>
        <option value="Morning">Morning</option>
        <option value="Afternoon">Afternoon</option>
        <option value="Evening">Evening</option>
      </select>
    </div>


    <div>
      <label class="mb-1.5 block text-sm font-medium text-[#4f4138]">Regarding</label>
      <textarea name="regarding" rows="4" class="w-full rounded-[18px] border border-[#d9cdc3] bg-white px-4 py-3 text-sm text-[#231b17] outline-none transition focus:border-[#231b17] focus:ring-4 focus:ring-[#231b17]/8 resize-none" placeholder="What is this about?" required></textarea>
    </div>
  </div>


  <!-- Honeypot (spam protection) -->
  <div style="display:none">
    <input type="text" name="_gotcha" style="display:none" />
  </div>


  <button type="submit" class="mt-6 w-full rounded-[18px] bg-[#231b17] py-3 text-sm font-semibold text-white transition hover:bg-[#3a2f29]">
    Request Callback
  </button>
</form>

What is a Callback Request?

A callback request form template lets website visitors ask your team to call them back at a convenient time. This HTML form collects a phone number, preferred time slot, and a brief description of what the call is about. Ideal for sales teams, customer service departments, and professional services.

Frequently Asked Questions

Common questions about request form templates.

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Start with this Callback Request

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