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Drop-down menus within pop-up

Hello,

 

I am trying to add a pop-up window to my financial services website so that when users first arrive they are asked to enter their region and whether they professional or retail customer. Depending on their answer, they will either be admitted or refused access to the website. This doesn't seem possible with the standard pop-up options that Weebly has.

 

Any suggestions for how this can be achieved would be greatly appreciated?

 

Thanks!

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