<form-template> <fields> <field type="text" subtype="text" required="true" label="Name:" class="form-control text-input" name="text-1678228106713"></field> <field type="text" subtype="text" required="true" label="Civic Address:" class="form-control text-input" name="text-1678228138635"></field> <field type="text" subtype="text" required="true" label="Road ____ between Road ____ &amp; Road ____ (ex: Road 44N between Road 150W and 151W):" class="form-control text-input" name="text-1678228174118"></field> <field type="checkbox-group" required="true" label="Has the location changed from last year?" class="checkbox-group" name="checkbox-group-1647363228985"> <option value="No" selected="true">No</option> <option value="Yes">Yes</option> </field> <field type="text" subtype="text" label="Describe new location:" class="form-control text-input" name="text-1678228202341"></field> <field type="checkbox-group" required="true" label="Length of Strip" class="checkbox-group" name="checkbox-group-1647362764740"> <option value="500 ft ($250.00)" selected="true">500 ft ($250.00)</option> <option value="750 ft ($375.00)">750 ft ($375.00)</option> <option value="1000ft ($500.00)">1000ft ($500.00)</option> </field> <field type="text" subtype="text" label="Other:" class="form-control text-input" name="text-1678228232538"></field> <field type="checkbox-group" required="true" label="Request Application For:" class="checkbox-group" name="checkbox-group-1678228564264"> <option value="Spring Application" selected="true">Spring Application</option> <option value="Summer Application ">Summer Application (invoice will be sent)</option> </field> <field type="text" subtype="text" required="true" label="Contact Phone Number:" class="form-control text-input" name="text-1678227991435"></field> <field type="text" subtype="text" required="true" label="Contact Email Address: " class="form-control text-input" name="text-1647367951084"></field> <field type="checkbox" required="true" label="Dust control strips are 16 feet wide and a minimum of 500 feet in length. The Municipality does not guarantee dust suppression effectiveness. The Municipality reserves the right to perform any maintenance procedures as it deems necessary on the treated portions of the municipal road. In the event of an unsafe driving conditions, the Municipality will not accept any liability for restoring the road to a safe condition. By signing below, I am requesting dust control to be applied at the above location and understand the terms and conditions of PW-002 – Dust Control Policy." class="checkbox" name="checkbox-1647367836121"></field> <field type="text" subtype="text" required="true" label="Date:" class="form-control text-input" name="text-1647367866180"></field> <field type="paragraph" subtype="p" label="Please send an e-transfer to accounts@rmofpipestone.com or make a cheque payable to the RM of Pipestone. " class="paragraph"></field> </fields> </form-template> Submit Submitting...
