DerekTestComplete/Form2.html at main · CaptainExtremis/DerekTestComplete · GitHub

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<!DOCTYPE html>
<p><small>120 Barrington Ave.</small></p><br>
<p><small></small>East Dundee, IL, 60118.</small></p>
<br>
<h1>Freedom of Information Act (FOIA) Request Form</h1>
<form>
    <label for="name">Name</label>
    <input type="text" id="name" name="name">
    <label for="phone">Phone</label>
    <input type="number" id="phone" name="phone">
    <label for="currdate">Date</label>
    <input type="date" id="currdate" name="currdate"><br>


    <label for="address">Address</label>
    <input type="text" id="address" name="address">
    <label for="city">City</label>
    <input type="text" id="city" name="city">
    <label for="state">State</label>
    <input type="text" id="state" name="state">
    <label for="zip">Zip</label>
    <input type="number" id="zip" name="zip"><br>

    <label for="email">Email</label>
    <input type="email" id="email" name="email"><br>

    <label for="records">Records Requested</label>
    <textarea name="request" rows="5" cols="30"></textarea><br>

    <p>Is this request for a commercial purpose?</p>
    <input type="radio" id="yes" name="yes" value="Yes">
    <label for="yes">Yes</label><br>
    <input type="radio" id="no" name="no" value="No">
    <label for="no">No</label><br>

    <p>Are you requesting a fee waiver?</p>
    <input type="radio" id="yes" name="yes" value="Yes">
    <label for="yes">Yes</label><br>
    <input type="radio" id="no" name="no" value="No">
    <label for="no">No</label><br>
</form>