Conversion Optimization 101: Form Folly

There were some excellent responses last week’s CRO challenge post on a NetFlix ad and landing page mismatch. Thank you all!

Today’s challenge is to explain how you would improve and optimize the form below . While the page looks polished and professional,  it is creating cognitive friction for visitors. You can be certain that where there is friction there is opportunity for optimization.

Please be sure to click on the image to enlarge it and then provide a short list of your suggestions as a comment:

 

We look forward to reading your comments.

*Update: to read the follow up post see:

Conversion Optimization 101: Optimizing Complex Web Forms (w/ 10 Point Checklist)

Please share if you think others would benefit.