smoothunit

Hi,

Hoping someone can help point me in the right direction to replicate this optin form by Bob Ross (product was TrapFunnel). Unfortunately he says its just a basic form with little (read none) explanation of what he used to create it.

I've attached an image to better show how it works;
Example Optin Page

From what I can tell from the photo- the first step is to enter your address. Once done the second part of the optin requests your name and email, send it to me and done.

I've used (and use) a few form creators that use conditional logic but all are limited without a boat load of custom work. I simply would like this basic page with the double optin.

Any and all input is appreciated.