Inputs

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Label

One

Two

Three

Four

One

Two

Three

Four

What is your request?

Maximum 1000 characters

HTML

<div class="container mb-4"> <div class="row"> <div class="col-12 offset-1 col-md-10 offset-md-2 col-lg-9 col-xl-8"> <div id="content_0_main_2_pnlFormFeedback"> </div> <div id="content_0_main_2_pnlForm" class="mb--s"> <div id="content_0_main_2_ctl00" class="scfValidationSummary" style="display:none;"> </div> <fieldset class="my-0"> <legend class="mb--xxs">Fill in details below</legend> <div class="mb--xs"> <label for="content_0_main_2_txtFirstName" id="content_0_main_2_lblFirstName" class="scfSingleLineTextLabel">Label</label> <div class="scfSingleLineGeneralPanel"> <input name="content_0$main_2$txtFirstName" type="text" maxlength="200" id="content_0_main_2_txtFirstName" class="scfSingleLineTextBox"> <span id="content_0_main_2_regExpValFirstName" class="scfValidator" style="display:none;">First Name is not valid. Only letters, spaces, hyphens and apostrophes can be entered.</span> <div data-lastpass-icon-root="true" style="position: relative !important;height: 0px !important;width: 0px !important;float: left !important;"></div> </div> <span id="content_0_main_2_reqFieldFirstName" class="scfValidatorRequired" style="display:none;">First Name is a mandatory field.</span> </div> </fieldset> <fieldset class="my-0"> <div class="mb--xs"> <table id="content_0_main_2_rdoCemeteries" class="radiobuttonlist mt--xxs"> <tbody> <tr> <td><input id="content_0_main_2_rdoCemeteries_0" type="radio" name="content_0$main_2$rdoCemeteries" value="All" checked="checked"><label for="content_0_main_2_rdoCemeteries_0">One</label></td> </tr> <tr> <td><input id="content_0_main_2_rdoCemeteries_1" type="radio" name="content_0$main_2$rdoCemeteries" value="Karori"><label for="content_0_main_2_rdoCemeteries_1">Two</label></td> </tr> <tr> <td><input id="content_0_main_2_rdoCemeteries_2" type="radio" name="content_0$main_2$rdoCemeteries" value="Makara"><label for="content_0_main_2_rdoCemeteries_2">Three</label></td> </tr> <tr> <td><input id="content_0_main_2_rdoCemeteries_3" type="radio" name="content_0$main_2$rdoCemeteries" value="Bolton St"><label for="content_0_main_2_rdoCemeteries_3">Four</label></td> </tr> </tbody> </table> </div> <div class="scfCheckBoxListBorder"> <div class="scfCheckBoxListGeneralPanel"> <table id="content_0_main_0_components_1_chkListGroups" class="scfCheckBoxList"> <tbody> <tr> <td><input id="content_0_main_0_components_1_chkListGroups_0" type="checkbox" name="content_0$main_0$components_1$chkListGroups$0" value="Alcohol licence applications"><label for="content_0_main_0_components_1_chkListGroups_0">One</label></td> </tr> <tr> <td><input id="content_0_main_0_components_1_chkListGroups_1" type="checkbox" name="content_0$main_0$components_1$chkListGroups$1" value="Our Wellington news"><label for="content_0_main_0_components_1_chkListGroups_1">Two</label></td> </tr> <tr> <td><input id="content_0_main_0_components_1_chkListGroups_2" type="checkbox" name="content_0$main_0$components_1$chkListGroups$2" value="Recent resource consents - issued and applied for"><label for="content_0_main_0_components_1_chkListGroups_2">Three</label></td> </tr> <tr> <td><input id="content_0_main_0_components_1_chkListGroups_3" type="checkbox" name="content_0$main_0$components_1$chkListGroups$3" value="Final one for value"><label for="content_0_main_0_components_1_chkListGroups_3">Four</label></td> </tr> </tbody> </table> </div> </div> <div class="mb--xs"> <label for="content_0_main_2_txtComments" id="content_0_main_2_lblComments" class="scfMultipleLineTextLabel">What is your request?</label> <div class="mb--xs"> <textarea name="content_0$main_2$txtComments" rows="5" cols="30" id="content_0_main_2_txtComments" class="mb--xxs">

Maximum 1000 characters

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