Call back in 15 minute plugin

  • Is anyone aware of a plugin that can be used as a floating/lightbox (?not sure of the terminology) form to fill out with the visitors information – something along the lines of
    Name
    email
    tel.nos.
    Problem
    additional info
    best time to call

    Wanted to add it into a genesis pro theme
    Was hoping they could hover over an image and have a box popup that could be filled out and directly emailed to my phone so I could contact them, without them having to leaver the page.
    Wanted to be able to repeat this across multiple pages

    Tried using the eNews extended plugin but that seems to be restricted to 3 fields only

    No need for a link to new site as I haven’t got there yet but current site has between 20 and 30 visitors per day and i want to try to convert them into customers better, hence the site update
    It is for a local area website offering drain services and pest control services

    I appreciate any assistance that you can offer

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