Crystal City Digital Sign Online Ad Form <form-template> <fields> <field type="select" required="true" label=" Type of Ad (community group, personal or business)" description="Please select one of the types from the dropdown list" placeholder="Type here" class="form-control select" name="select-1655323577394"> <option value="Community Group" selected="true">Community Group</option> <option value="Personal">Personal</option> <option value="Business">Business</option> </field> <field type="text" subtype="text" required="true" label="Your First Name" description="Please type your first name" placeholder="Type here ....." class="form-control text-input" name="text-1655320822385"></field> <field type="text" subtype="text" required="true" label="Your Last Name" description="Please type your last name" placeholder="Type here....." class="form-control text-input" name="text-1655318917047"></field> <field type="text" subtype="text" label="Your Organization or Business Name (if applicable)" description="Please type Organization or Business Name (if applicable)" placeholder="Type here ...." class="form-control text-input" name="text-1655320819306"></field> <field type="text" subtype="text" label="Your Phone Number" description="Please enter your 10 digit number" placeholder="Enter here ....." class="form-control text-input" name="text-1655323864364"></field> <field type="text" subtype="email" required="true" label="Your email" description="Please enter your email address" placeholder="Enter here ....." class="form-control text-input" name="text-1655323987340"></field> <field type="date" required="true" label="Requested Start Date for the Ad display" description="Please select the date you'd like the ad to start being displayed" class="form-control calendar" name="date-1655324078807" value="requested start date"></field> <field type="date" required="true" label="End Date for the Ad display" description="Please select the final day for the Ad display " class="form-control calendar" name="date-1655324597344" value="end date"></field> <field type="date" label="Event date (if applicable)" description="Please select the event date (if more than one day please show them in the Ad Information section below)" class="form-control calendar" name="date-1655324417410" value="event date"></field> <field type="paragraph" subtype="p" label=" " class="paragraph"></field> <field type="paragraph" subtype="p" label="Ad Information to be displayed (please ensure correct spelling)" class="paragraph"></field> <field type="paragraph" subtype="p" label="If you have a picture, poster, logo or other file with info for use in the Ad, please upload them here" class="paragraph"></field> <field type="paragraph" subtype="p" label=" " class="paragraph"></field> <field type="file" label="File Upload" description="If you have a picture, poster, logo or other file of the content you would like in the Ad please upload them here" class="form-control file-input" name="file-1655324875627" multiple="true"></field> <field type="paragraph" subtype="p" label=" " class="paragraph"></field> <field type="paragraph" subtype="address" label="And/or enter Ad information here" class="paragraph"></field> <field type="textarea" label="Ad information to be included" description="Please enter the Ad information here if not uploaded above or if you have additional info to add or highlight" placeholder="Please enter here ....." class="form-control text-area" name="textarea-1655325375702"></field> <field type="textarea" label="Please enter any other info, special requests, etc. here" description="Please enter here" placeholder="Please enter here" class="form-control text-area" name="textarea-1655758156669"></field> <field type="paragraph" subtype="p" label=" " class="paragraph"></field> <field type="checkbox" label="If you would like to see a copy (proof) before the Ad goes live, Please check here " description="Please check the box if you would like a preview" class="checkbox" name="checkbox-1656277559272"></field> <field type="header" subtype="h1" label=" " class="header"></field> <field type="paragraph" subtype="p" label="Payment may be made on-line by Interac e-transfer to CC Chamber at ccsign4@gmail.com" class="paragraph"></field> <field type="paragraph" subtype="p" label="Or, by cheque made payable to CC &amp; District Chamber of Commerce, dropped off at the Municipal office " class="paragraph"></field> <field type="radio-group" required="true" label="Payment method you have selected" description="Please select one of the following" class="radio-group" name="radio-group-1655831798284"> <option value="No payment required; my Ad is free" selected="true">No payment required; my Ad is free</option> <option value="Interac e-transfer to the Chamber">Interac e-transfer to the Chamber</option> <option value="Cheque payable to the Chamber">Cheque payable to the Chamber</option> </field> <field type="paragraph" subtype="p" label=" " class="paragraph"></field> <field type="text" subtype="text" required="true" label="Signature (Initial and Last Name)" description="Please type in your initial and last name" placeholder="Signature" class="form-control text-input" name="text-1655843294920"></field> <field type="date" required="true" label="Date submitted" description="Please select today's date" class="form-control calendar" name="date-1655326270315" value="Date submitted"></field> </fields> </form-template> Submit Submitting...
