What Ortiz Blum does with a name and a number.

The note asks for your name, phone, street, and the job. Gina Ortiz or Seth Blum uses it to call you back. It is not sold.

The form does not write to a database. The next screen shows what you sent. When you leave that screen, the site is not holding a copy. The paper at the shop starts when a job is booked.