Hello
Thanks for the project posting. I have just studied the project description and I have understood that you want a page developed in HTML that when the user will encounter a Block Page, s/he would have the opportunity to submit a ticket with the information right from that page ( name, email and reason) . Well, I can complete this project as per your expectations. I am a web developer having 6 years of experience. So, lets have a quick chat so that I can start work immediately.
You can see my work here
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Thanks
Mike