<form-template> <fields> <field type="checkbox-group" required="true" label="ACCOUNT CHANGE (PLEASE CHECK ALL THAT APPLY)" class="checkbox-group" name="checkbox-group-1616524111133"> <option value="option-1" selected="true">UTILITY</option> <option value="option-2">PROPERTY TAXES</option> <option>BOTH</option> </field> <field type="text" subtype="text" required="true" label="NAME THAT IS REGISTERED TO THE ACCOUNT" class="form-control text-input" name="text-1616524195420"></field> <field type="text" subtype="text" required="true" label="PHONE NUMBER" class="form-control text-input" name="text-1616524275395"></field> <field type="text" subtype="email" label="EMAIL ADDRESS" class="form-control text-input" name="text-1616524302180"></field> <field type="text" subtype="text" required="true" label="OLD CIVIC ADDRESS" class="form-control text-input" name="text-1616524318523"></field> <field type="text" subtype="text" required="true" label="NEW CIVIC ADDRESS" class="form-control text-input" name="text-1616524319675"></field> <field type="text" subtype="text" required="true" label="NEW MAILING ADDRESS " class="form-control text-input" name="text-1616524320114"></field> <field type="date" required="true" label="MOVE DATE" class="form-control calendar" name="date-1616524375228"></field> </fields> </form-template> Submit Submitting...
