<form-template> <fields> <field type="text" subtype="text" required="true" label="Service Address:" class="form-control text-input" name="text-1655237967226"></field> <field type="checkbox-group" required="true" label="You are:" class="checkbox-group" name="checkbox-group-1655237994771"> <option value="option-1" selected="true">Home Owner</option> <option value="option-2">Tenant </option> </field> <field type="header" subtype="h1" label="Home Owner Information " class="header"></field> <field type="text" subtype="text" required="true" label="Name:" class="form-control text-input" name="text-1655238125642"></field> <field type="text" subtype="text" required="true" label="Mailing Address:" class="form-control text-input" name="text-1655238143712"></field> <field type="text" subtype="text" required="true" label="Phone Number:" class="form-control text-input" name="text-1655238161668"></field> <field type="text" subtype="text" label="Email:" class="form-control text-input" name="text-1655238178135"></field> <field type="header" subtype="h1" label="Tenant Information" class="header"></field> <field type="text" subtype="text" label="Name:" class="form-control text-input" name="text-1655238203167"></field> <field type="text" subtype="text" label="Mailing Address:" class="form-control text-input" name="text-1655238212837"></field> <field type="text" subtype="text" label="Phone Number:" class="form-control text-input" name="text-1655238226967"></field> <field type="text" subtype="text" label="Email:" class="form-control text-input" name="text-1655238238339"></field> <field type="select" required="true" label="How do you want to receive a bill?" class="form-control select" name="select-1655238272005" multiple="true"> <option value="option-1">Paper</option> <option value="(Please fill out Emailed Utility Bill Setup ">Email Bill</option> <option>Pre-Authorized Payment</option> </field> <field type="textarea" required="true" label="By making this request for service, I acknowledge the RM of Pipestone will provide the home owner with copies of all correspondence related to the service, including, but not limited to invoices, requests for payment and disconnection notices. I further acknowledge that the RM of Pipestone will release status of the account to the homeowner upon request. (Type &quot;yes&quot; if you agree to terms)" class="form-control text-area" name="textarea-1655238394375"></field> <field type="text" subtype="text" required="true" label="Signature (Type your name):" class="form-control text-input" name="text-1655238413825"></field> </fields> </form-template> Submit Submitting...
