<form-template> <fields> <field type="text" subtype="text" required="true" label="First Name" placeholder="First Name" class="form-control text-input" name="text-1586445017095" value="First Name"></field> <field type="text" subtype="text" required="true" label="Last Name" placeholder="Last Name" class="form-control text-input" name="text-1586445117494" value="Last Name"></field> <field type="text" subtype="text" required="true" label="Service Address" description="Civic address " placeholder="Service Address" class="form-control text-input" name="text-1586445148890" value="eg. 123 4 Street"></field> <field type="date" required="true" label="Service End Date" description="Possession date or end date of lease agreement" class="form-control calendar" name="date-1586445519347" value="mm/dd/yyyy"></field> <field type="text" subtype="text" required="true" label="Phone Number" placeholder="Phone Number" class="form-control text-input" name="text-1586446287463" value="eg. 000-123-4567"></field> <field type="paragraph" subtype="p" label="A final reading will be taken and the finalized bill will be sent to you after the effective/service end date. If you have put a deposit on your account, it will be applied to any outstanding balance on your final bill. If a credit balance remains on your account after final billing, the balance will be refunded to you by cheque." class="paragraph"></field> <field type="text" subtype="text" required="true" label="Mailing Address" placeholder="Mailing Address" class="form-control text-input" name="text-1586445303254" value="eg. Box 123"></field> <field type="text" subtype="text" required="true" label="City or Town" placeholder="City or Town" class="form-control text-input" name="text-1586446557189"></field> <field type="text" subtype="text" required="true" label="Postal Code" placeholder="Postal Code" class="form-control text-input" name="text-1586446600591"></field> </fields> </form-template> Submit Submitting...
