<form-template> <fields> <field type="checkbox-group" required="true" label="Payment received:" class="checkbox-group" name="checkbox-group-1680713229515"> <option value=" Criminal Record Check—$40 payable to the Town of Didsbury" selected="true"> Criminal Record Check—$40 payable to the Town of Didsbury</option> <option value=" Fingerprinting—$25 payable to the Town of Didsbury (Note: an additional $25 is payable to Receiver General, at the RCMP station)"> Fingerprinting—$25 payable to the Town of Didsbury (Note: an additional $25 is payable to Receiver General, at the RCMP station)</option> </field> <field type="text" subtype="text" required="true" label="Total Ampount:" description="Total amount paid" placeholder="$" class="form-control text-input" name="text-1680713316142"></field> <field type="text" subtype="text" required="true" label="Name:" placeholder="First and last name" class="form-control text-input" name="text-1680713383251"></field> <field type="textarea" required="true" label="Mailing address:" class="form-control text-area" name="textarea-1680713435127"></field> <field type="textarea" label="Email address:" class="form-control text-area" name="textarea-1680713468110"></field> <field type="radio-group" required="true" label="Receipt Options:" class="radio-group" name="radio-group-1680713571947"> <option value=" Yes, I would like a receipt for my payment" selected="true"> Yes, I would like a receipt for my payment</option> <option value=" No, I do not require a receipt for my payment"> No, I do not require a receipt for my payment</option> </field> <field type="radio-group" label="If you require a receipt for your payment:" class="radio-group" name="radio-group-1680713671003"> <option value=" I would like to have my receipt emailed to me at the above email address" selected="true"> I would like to have my receipt emailed to me at the above email address</option> <option value=" I would like to have my receipt mailed to me at the above mailing address"> I would like to have my receipt mailed to me at the above mailing address</option> </field> <field type="radio-group" required="true" label="Payment options:" class="radio-group" name="radio-group-1680713664573"> <option value="Cash, paid in-person at the Didsbury RCMP station" selected="true">Cash, paid in-person at the Didsbury RCMP station</option> <option value="Debit, paid in-person at the Didsbury RCMP station">Debit, paid in-person at the Didsbury RCMP station</option> <option value="Credit, paid in-person at the Didsbury RCMP station">Credit, paid in-person at the Didsbury RCMP station</option> <option value="E-transfer to finance@didsbury.ca">E-transfer to finance@didsbury.ca</option> <option value=" Cheque, made to the Town of Didsbury (drop off at the Town Office at 1606 14 Street, or mail to Box 790)"> Cheque, made to the Town of Didsbury (drop off at the Town Office at 1606 14 Street, or mail to Box 790)</option> </field> </fields> </form-template> Submit Submitting...
