"Anuncie Aqui"
Bootstrap 4.1.1 Snippet by Izabelle95

<link href="//maxcdn.bootstrapcdn.com/bootstrap/4.1.1/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css"> <script src="//maxcdn.bootstrapcdn.com/bootstrap/4.1.1/js/bootstrap.min.js"></script> <script src="//cdnjs.cloudflare.com/ajax/libs/jquery/3.2.1/jquery.min.js"></script> <!------ Include the above in your HEAD tag ----------> <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01//EN" "http://www.w3.org/TR/html4/strict.dtd"> <html class="supernova"><head> <meta http-equiv="Content-Type" content="text/html; charset=utf-8" /> <link rel="alternate" type="application/json+oembed" href="https://www.jotform.com/oembed/?format=json&url=https%3A%2F%2Fform.jotform.com%2F202666328230653" title="oEmbed Form"> <link rel="alternate" type="text/xml+oembed" href="https://www.jotform.com/oembed/?format=xml&url=https%3A%2F%2Fform.jotform.com%2F202666328230653" title="oEmbed Form"> <meta property="og:title" content="Event RSVP Form" > <meta property="og:url" content="https://form.jotform.com/202666328230653" > <meta property="og:description" content="Please click the link to complete this form."> <meta name="slack-app-id" content="AHNMASS8M"> <link rel="shortcut icon" href="https://cdn.jotfor.ms/favicon.ico"> <link rel="canonical" href="https://form.jotform.com/202666328230653" /> <meta name="viewport" content="width=device-width, initial-scale=1.0, maximum-scale=2.0, user-scalable=1" /> <meta name="HandheldFriendly" content="true" /> <title>Anuncie aqui </title> <link href="https://cdn.jotfor.ms/static/formCss.css?3.3.20463" rel="stylesheet" type="text/css" /> <link type="text/css" media="print" rel="stylesheet" href="https://cdn.jotfor.ms/css/printForm.css?3.3.20463" /> <link type="text/css" rel="stylesheet" href="https://cdn.jotfor.ms/css/styles/nova.css?3.3.20463" /> <link type="text/css" rel="stylesheet" href="https://cdn.jotfor.ms/themes/CSS/566a91c2977cdfcd478b4567.css?themeRevisionID=59fb4852cf3bfe589c6c6f21"/> <link type="text/css" rel="stylesheet" href="https://cdn.jotfor.ms/css/styles/payment/payment_feature.css?3.3.20463" /> <style type="text/css"> .form-label-left{ width:150px; } .form-line{ padding-top:12px; padding-bottom:12px; } .form-label-right{ width:150px; } body, html{ margin:0; padding:0; background:#fff; } .form-all{ margin:0px auto; padding-top:0px; width:651px; color:#555 !important; font-family:"Lucida Grande", "Lucida Sans Unicode", "Lucida Sans", Verdana, sans-serif; font-size:14px; } .form-radio-item label, .form-checkbox-item label, .form-grading-label, .form-header{ color: false; } </style> <style type="text/css" id="form-designer-style"> /* Injected CSS Code */ /*PREFERENCES STYLE*/ .form-all { font-family: Lucida Grande, sans-serif; } .form-all .qq-upload-button, .form-all .form-submit-button, .form-all .form-submit-reset, .form-all .form-submit-print { font-family: Lucida Grande, sans-serif; } .form-all .form-pagebreak-back-container, .form-all .form-pagebreak-next-container { font-family: Lucida Grande, sans-serif; } .form-header-group { font-family: Lucida Grande, sans-serif; } .form-label { font-family: Lucida Grande, sans-serif; } .form-label.form-label-auto { display: block; float: none; text-align: left; width: 100%; } .form-line { margin-top: 12px 36px 12px 36px px; margin-bottom: 12px 36px 12px 36px px; } .form-all { max-width: 651px; width: 100%; } .form-label.form-label-left, .form-label.form-label-right, .form-label.form-label-left.form-label-auto, .form-label.form-label-right.form-label-auto { width: 150px; } .form-all { font-size: 14px } .form-all .qq-upload-button, .form-all .qq-upload-button, .form-all .form-submit-button, .form-all .form-submit-reset, .form-all .form-submit-print { font-size: 14px } .form-all .form-pagebreak-back-container, .form-all .form-pagebreak-next-container { font-size: 14px } .supernova .form-all, .form-all { background-color: #fff; border: 1px solid transparent; } .form-all { color: #555; } .form-header-group .form-header { color: #555; } .form-header-group .form-subHeader { color: #555; } .form-label-top, .form-label-left, .form-label-right, .form-html, .form-checkbox-item label, .form-radio-item label { color: #555; } .form-sub-label { color: #6f6f6f; } .supernova { background-color: undefined; } .supernova body { background: transparent; } .form-textbox, .form-textarea, .form-dropdown, .form-radio-other-input, .form-checkbox-other-input, .form-captcha input, .form-spinner input { background-color: undefined; } .supernova { background-image: none; } #stage { background-image: none; } .form-all { background-image: none; } .ie-8 .form-all:before { display: none; } .ie-8 { margin-top: auto; margin-top: initial; } /*PREFERENCES STYLE*//*__INSPECT_SEPERATOR__*/ /* Injected CSS Code */ </style> <script src="https://cdnjs.cloudflare.com/ajax/libs/punycode/1.4.1/punycode.min.js"></script> <script src="https://cdn.jotfor.ms/static/prototype.forms.js" type="text/javascript"></script> <script src="https://cdn.jotfor.ms/static/jotform.forms.js?3.3.20463" type="text/javascript"></script> <script type="text/javascript"> JotForm.init(function(){ setTimeout(function() { $('input_29').hint('ex: myname@example.com'); }, 20); setTimeout(function() { $('input_87').hint('ex: 23'); }, 20); if (window.JotForm && JotForm.accessible) $('input_15').setAttribute('tabindex',0); JotForm.newDefaultTheme = false; JotForm.newPaymentUIForNewCreatedForms = false; /*INIT-END*/ }); JotForm.prepareCalculationsOnTheFly([null,null,null,null,null,null,null,null,null,null,null,null,null,{"name":"submitForm13","qid":"13","text":"Submit Form","type":"control_button"},null,{"name":"comments","qid":"15","subLabel":"Please Enter any questions or concerns that you dont see listed on the form","text":"Comments","type":"control_textarea"},null,{"name":"reserveFor","qid":"17","text":"Reserve for","type":"control_radio"},null,{"name":"clickTo","qid":"19","text":"Attendance","type":"control_head"},null,null,null,null,null,null,{"name":"wePrefer","qid":"26","text":"We prefer a room on the","type":"control_radio"},null,{"name":"fullName28","qid":"28","text":"Nome do Estabelecimento","type":"control_fullname"},{"name":"email29","qid":"29","text":"E-mail","type":"control_email"},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"name":"clickTo53","qid":"53","text":"Anuncie aqui!!!","type":"control_head"},{"name":"clickTo54","qid":"54","text":"Accommodations","type":"control_head"},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"name":"roomsNeeded","qid":"79","subLabel":"Each additional room is 295.00","text":"Rooms needed","type":"control_dropdown"},null,null,null,{"name":"address83","qid":"83","text":"Endereco","type":"control_address"},null,null,null,{"name":"numbersOf","qid":"87","text":"Numbers of People Attending","type":"control_number"},{"name":"pageBreak","qid":"88","text":"Page Break","type":"control_pagebreak"},{"name":"pageBreak89","qid":"89","text":"Page Break","type":"control_pagebreak"},{"name":"phoneNumber90","qid":"90","text":"CNPJ","type":"control_phone"},{"description":"","name":"phoneNumber","qid":"91","text":"Telefone","type":"control_phone"},{"description":"","name":"telefone","qid":"92","text":"Celular","type":"control_phone"}]); setTimeout(function() { JotForm.paymentExtrasOnTheFly([null,null,null,null,null,null,null,null,null,null,null,null,null,{"name":"submitForm13","qid":"13","text":"Submit Form","type":"control_button"},null,{"name":"comments","qid":"15","subLabel":"Please Enter any questions or concerns that you dont see listed on the form","text":"Comments","type":"control_textarea"},null,{"name":"reserveFor","qid":"17","text":"Reserve for","type":"control_radio"},null,{"name":"clickTo","qid":"19","text":"Attendance","type":"control_head"},null,null,null,null,null,null,{"name":"wePrefer","qid":"26","text":"We prefer a room on the","type":"control_radio"},null,{"name":"fullName28","qid":"28","text":"Nome do Estabelecimento","type":"control_fullname"},{"name":"email29","qid":"29","text":"E-mail","type":"control_email"},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"name":"clickTo53","qid":"53","text":"Anuncie aqui!!!","type":"control_head"},{"name":"clickTo54","qid":"54","text":"Accommodations","type":"control_head"},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"name":"roomsNeeded","qid":"79","subLabel":"Each additional room is 295.00","text":"Rooms needed","type":"control_dropdown"},null,null,null,{"name":"address83","qid":"83","text":"Endereco","type":"control_address"},null,null,null,{"name":"numbersOf","qid":"87","text":"Numbers of People Attending","type":"control_number"},{"name":"pageBreak","qid":"88","text":"Page Break","type":"control_pagebreak"},{"name":"pageBreak89","qid":"89","text":"Page Break","type":"control_pagebreak"},{"name":"phoneNumber90","qid":"90","text":"CNPJ","type":"control_phone"},{"description":"","name":"phoneNumber","qid":"91","text":"Telefone","type":"control_phone"},{"description":"","name":"telefone","qid":"92","text":"Celular","type":"control_phone"}]);}, 20); </script> </head> <body> <form class="jotform-form" action="https://submit.jotform.com/submit/202666328230653/" method="post" name="form_202666328230653" id="202666328230653" accept-charset="utf-8" autocomplete="on"> <input type="hidden" name="formID" value="202666328230653" /> <input type="hidden" id="JWTContainer" value="" /> <input type="hidden" id="cardinalOrderNumber" value="" /> <div role="main" class="form-all"> <ul class="form-section page-section"> <li id="cid_53" class="form-input-wide" data-type="control_head"> <div class="form-header-group header-large"> <div class="header-text httac htvam"> <h1 id="header_53" class="form-header" data-component="header"> Que tal ter o seu hotel ou pousada sendo anunciada por nós?! </h1> <div id="subHeader_53" class="form-subHeader"> Preencha aqui o formulário abaixo com os dados do seu estabelecimento. </div> </div> </div> </li> <li class="form-line jf-required" data-type="control_fullname" id="id_28" data-compound-hint=","> <label class="form-label form-label-left" id="label_28" for="first_28"> Nome do Estabelecimento <span class="form-required"> * </span> </label> <div id="cid_28" class="form-input jf-required"> <div data-wrapper-react="true"> <span class="form-sub-label-container " style="vertical-align:top" data-input-type="first"> <input type="text" id="first_28" name="q28_fullName28[first]" class="form-textbox validate[required]" size="10" value="" data-component="first" aria-labelledby="label_28" required="" /> </span> <span class="form-sub-label-container " style="vertical-align:top" data-input-type="last"> <input type="text" id="last_28" name="q28_fullName28[last]" class="form-textbox validate[required]" size="15" value="" data-component="last" aria-labelledby="label_28" required="" /> </span> </div> </div> </li> <li class="form-line" data-type="control_phone" id="id_90" data-compound-hint=","> <label class="form-label form-label-left" id="label_90" for="input_90_area"> CNPJ </label> <div id="cid_90" class="form-input"> <div data-wrapper-react="true"> <span class="form-sub-label-container " style="vertical-align:top" data-input-type="areaCode"> <input type="tel" id="input_90_area" name="q90_phoneNumber90[area]" class="form-textbox" value="" data-component="areaCode" aria-labelledby="label_90" /> <span class="phone-separate" aria-hidden="true">  - </span> <label class="form-sub-label" for="input_90_area" id="sublabel_90_area" style="min-height:13px" aria-hidden="false"> </label> </span> <span class="form-sub-label-container " style="vertical-align:top" data-input-type="phone"> <input type="tel" id="input_90_phone" name="q90_phoneNumber90[phone]" class="form-textbox" value="" data-component="phone" aria-labelledby="label_90" /> <label class="form-sub-label" for="input_90_phone" id="sublabel_90_phone" style="min-height:13px" aria-hidden="false"> </label> </span> </div> </div> </li> <li class="form-line" data-type="control_phone" id="id_91"> <label class="form-label form-label-left" id="label_91" for="input_91_area"> Telefone </label> <div id="cid_91" class="form-input"> <div data-wrapper-react="true"> <span class="form-sub-label-container " style="vertical-align:top" data-input-type="areaCode"> <input type="tel" id="input_91_area" name="q91_phoneNumber[area]" class="form-textbox" value="" data-component="areaCode" aria-labelledby="label_91 sublabel_91_area" /> <span class="phone-separate" aria-hidden="true">  - </span> <label class="form-sub-label" for="input_91_area" id="sublabel_91_area" style="min-height:13px" aria-hidden="false"> DDD </label> </span> <span class="form-sub-label-container " style="vertical-align:top" data-input-type="phone"> <input type="tel" id="input_91_phone" name="q91_phoneNumber[phone]" class="form-textbox" value="" data-component="phone" aria-labelledby="label_91 sublabel_91_phone" /> <label class="form-sub-label" for="input_91_phone" id="sublabel_91_phone" style="min-height:13px" aria-hidden="false"> Número </label> </span> </div> </div> </li> <li class="form-line" data-type="control_phone" id="id_92"> <label class="form-label form-label-left" id="label_92" for="input_92_area"> Celular </label> <div id="cid_92" class="form-input"> <div data-wrapper-react="true"> <span class="form-sub-label-container " style="vertical-align:top" data-input-type="areaCode"> <input type="tel" id="input_92_area" name="q92_telefone[area]" class="form-textbox" value="" data-component="areaCode" aria-labelledby="label_92 sublabel_92_area" /> <span class="phone-separate" aria-hidden="true">  - </span> <label class="form-sub-label" for="input_92_area" id="sublabel_92_area" style="min-height:13px" aria-hidden="false"> DDD </label> </span> <span class="form-sub-label-container " style="vertical-align:top" data-input-type="phone"> <input type="tel" id="input_92_phone" name="q92_telefone[phone]" class="form-textbox" value="" data-component="phone" aria-labelledby="label_92 sublabel_92_phone" /> <label class="form-sub-label" for="input_92_phone" id="sublabel_92_phone" style="min-height:13px" aria-hidden="false"> Número </label> </span> </div> </div> </li> <li class="form-line" data-type="control_email" id="id_29"> <label class="form-label form-label-left" id="label_29" for="input_29"> E-mail </label> <div id="cid_29" class="form-input"> <input type="email" id="input_29" name="q29_email29" class="form-textbox validate[Email]" size="30" value="" placeholder="ex: myname@example.com" data-component="email" aria-labelledby="label_29" /> </div> </li> <li class="form-line jf-required" data-type="control_address" id="id_83"> <label class="form-label form-label-left" id="label_83" for="input_83undefined"> Endereço <span class="form-required"> * </span> </label> <div id="cid_83" class="form-input jf-required"> <div summary="" class="form-address-table jsTest-addressField"> <div class="form-address-line-wrapper jsTest-address-line-wrapperField"> <span class="form-address-line form-address-street-line jsTest-address-lineField"> <span class="form-sub-label-container " style="vertical-align:top"> <input type="text" id="input_83_addr_line1" name="q83_address83[addr_line1]" class="form-textbox validate[required] form-address-line" value="" data-component="address_line_1" aria-labelledby="label_83 sublabel_83_addr_line1" /> <label class="form-sub-label" for="input_83_addr_line1" id="sublabel_83_addr_line1" style="min-height:13px" aria-hidden="false"> Rua </label> </span> </span> </div> <div class="form-address-line-wrapper jsTest-address-line-wrapperField"> <span class="form-address-line form-address-street-line jsTest-address-lineField"> <span class="form-sub-label-container " style="vertical-align:top"> <input type="text" id="input_83_addr_line2" name="q83_address83[addr_line2]" class="form-textbox form-address-line" value="" data-component="address_line_2" aria-labelledby="label_83 sublabel_83_addr_line2" /> <label class="form-sub-label" for="input_83_addr_line2" id="sublabel_83_addr_line2" style="min-height:13px" aria-hidden="false"> Bairo </label> </span> </span> </div> <div class="form-address-line-wrapper jsTest-address-line-wrapperField"> <span class="form-address-line form-address-city-line jsTest-address-lineField "> <span class="form-sub-label-container " style="vertical-align:top"> <input type="text" id="input_83_city" name="q83_address83[city]" class="form-textbox validate[required] form-address-city" value="" data-component="city" aria-labelledby="label_83 sublabel_83_city" /> <label class="form-sub-label" for="input_83_city" id="sublabel_83_city" style="min-height:13px" aria-hidden="false"> Cidade </label> </span> </span> <span class="form-address-line form-address-state-line jsTest-address-lineField "> <span class="form-sub-label-container " style="vertical-align:top"> <input type="text" id="input_83_state" name="q83_address83[state]" class="form-textbox validate[required] form-address-state" value="" data-component="state" aria-labelledby="label_83 sublabel_83_state" /> <label class="form-sub-label" for="input_83_state" id="sublabel_83_state" style="min-height:13px" aria-hidden="false"> Estado </label> </span> </span> </div> <span class="form-address-line form-address-country-line jsTest-address-lineField "> <span class="form-sub-label-container " style="vertical-align:top"> <select class="form-dropdown validate[required] form-address-country noTranslate" name="q83_address83[country]" id="input_83_country" data-component="country" required="" aria-labelledby="label_83 sublabel_83_country"> <option value="">Por favor selecione </option> <option value="Argentina"> Argentina </option> <option value="Brasil"> Brasil </option> <option value="Colombia">Colombia</option> <option value=""> Uruguai </option> </select> <label class="form-sub-label" for="input_83_country" id="sublabel_83_country" style="min-height:13px" aria-hidden="false"> País </label> </span> </span> </div> </div> </div> </li> <li id="cid_88" class="form-input-wide" data-type="control_pagebreak"> <div class="form-pagebreak" data-component="pagebreak"> <div class="form-pagebreak-back-container"> <button id="form-pagebreak-back_88" type="button" class="form-pagebreak-back jf-form-buttons" data-component="pagebreak-back"> </button> </div> <div class="form-pagebreak-next-container"> <button id="form-pagebreak-next_88" type="button" class="form-pagebreak-next jf-form-buttons" data-component="pagebreak-next"> OK </button> </div> </div> </li> </ul> <ul class="form-section page-section" style="display:none;"> <li id="cid_19" class="form-input-wide" data-type="control_head"> <div class="form-header-group header-small"> <div class="header-text httal htvam"> <h3 id="header_19" class="form-header" data-component="header"> Attendance </h3> </div> </div> </li> <li class="form-line" data-type="control_number" id="id_87"> <label class="form-label form-label-left" id="label_87" for="input_87"> Numbers of People Attending </label> <div id="cid_87" class="form-input"> <input type="number" id="input_87" name="q87_numbersOf" data-type="input-number" class=" form-number-input form-textbox validate[Numeric]" style="width:60px" size="5" value="" placeholder="ex: 23" data-component="number" aria-labelledby="label_87" step="any" /> </div> </li> <li class="form-line jf-required" data-type="control_radio" id="id_17"> <label class="form-label form-label-left" id="label_17" for="input_17"> Reserve for <span class="form-required"> * </span> </label> <div id="cid_17" class="form-input jf-required"> <div class="form-multiple-column" data-columncount="2" role="group" aria-labelledby="label_17" data-component="radio"> <span class="form-radio-item"> <span class="dragger-item"> </span> <input type="radio" class="form-radio validate[required]" id="input_17_0" name="q17_reserveFor" checked="" value="Couple" required="" /> <label id="label_input_17_0" for="input_17_0"> Couple </label> </span> <span class="form-radio-item"> <span class="dragger-item"> </span> <input type="radio" class="form-radio validate[required]" id="input_17_1" name="q17_reserveFor" value="Couple / Children" required="" /> <label id="label_input_17_1" for="input_17_1"> Couple / Children </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio validate[required]" id="input_17_2" name="q17_reserveFor" value="Single Male" required="" /> <label id="label_input_17_2" for="input_17_2"> Single Male </label> </span> <span class="form-radio-item"> <span class="dragger-item"> </span> <input type="radio" class="form-radio validate[required]" id="input_17_3" name="q17_reserveFor" value="Single Female" required="" /> <label id="label_input_17_3" for="input_17_3"> Single Female </label> </span> <span class="form-radio-item"> <input type="radio" class="form-radio-other form-radio validate[required]" name="q17_reserveFor" id="other_17" value="other" aria-label="Other" /> <label id="label_other_17" style="text-indent:0" for="other_17"> </label> <input type="text" class="form-radio-other-input form-textbox" name="q17_reserveFor[other]" data-otherhint="Other" size="15" id="input_17" placeholder="Other" /> <br/> </span> </div> </div> </li> <li class="form-line jf-required" data-type="control_dropdown" id="id_79"> <label class="form-label form-label-left" id="label_79" for="input_79"> Rooms needed <span class="form-required"> * </span> </label> <div id="cid_79" class="form-input jf-required"> <span class="form-sub-label-container " style="vertical-align:top"> <select class="form-dropdown validate[required]" id="input_79" name="q79_roomsNeeded" style="width:50px" data-component="dropdown" required="" aria-labelledby="label_79 sublabel_input_79"> <option value=""> </option> <option value="1"> 1 </option> <option value="2"> 2 </option> <option value="3"> 3 </option> <option value="4"> 4 </option> <option value="5"> 5 </option> <option value="6"> 6 </option> <option value="7"> 7 </option> <option value="8"> 8 </option> <option value="9"> 9 </option> <option value="10"> 10 </option> </select> <label class="form-sub-label" for="input_79" id="sublabel_input_79" style="min-height:13px" aria-hidden="false"> Each additional room is 295.00 </label> </span> </div> </li> <li id="cid_89" class="form-input-wide" data-type="control_pagebreak"> <div class="form-pagebreak" data-component="pagebreak"> <div class="form-pagebreak-back-container"> <button id="form-pagebreak-back_89" type="button" class="form-pagebreak-back jf-form-buttons" data-component="pagebreak-back"> Back </button> </div> <div class="form-pagebreak-next-container"> <button id="form-pagebreak-next_89" type="button" class="form-pagebreak-next jf-form-buttons" data-component="pagebreak-next"> Next </button> </div> <div style="clear:both" class="pageInfo form-sub-label" id="pageInfo_89"> </div> </div> </li> </ul> <ul class="form-section page-section" style="display:none;"> <li id="cid_54" class="form-input-wide" data-type="control_head"> <div class="form-header-group header-small"> <div class="header-text httal htvam"> <h3 id="header_54" class="form-header" data-component="header"> Accommodations </h3> </div> </div> </li> <li class="form-line jf-required" data-type="control_radio" id="id_26"> <label class="form-label form-label-left" id="label_26" for="input_26"> We prefer a room on the <span class="form-required"> * </span> </label> <div id="cid_26" class="form-input jf-required"> <div class="form-single-column" role="group" aria-labelledby="label_26" data-component="radio"> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio validate[required]" id="input_26_0" name="q26_wePrefer" value="No Preference" required="" /> <label id="label_input_26_0" for="input_26_0"> No Preference </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio validate[required]" id="input_26_1" name="q26_wePrefer" value="Lower Floors" required="" /> <label id="label_input_26_1" for="input_26_1"> Lower Floors </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio validate[required]" id="input_26_2" name="q26_wePrefer" value="Upper Floors" required="" /> <label id="label_input_26_2" for="input_26_2"> Upper Floors </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio validate[required]" id="input_26_3" name="q26_wePrefer" value="Can't walk stairs" required="" /> <label id="label_input_26_3" for="input_26_3"> Can't walk stairs </label> </span> </div> </div> </li> <li class="form-line" data-type="control_textarea" id="id_15"> <label class="form-label form-label-left" id="label_15" for="input_15"> Comments </label> <div id="cid_15" class="form-input"> <span class="form-sub-label-container " style="vertical-align:top"> <textarea id="input_15" class="form-textarea" name="q15_comments" cols="50" rows="6" data-component="textarea" aria-labelledby="label_15 sublabel_input_15"></textarea> <label class="form-sub-label" for="input_15" id="sublabel_input_15" style="min-height:13px" aria-hidden="false"> Please Enter any questions or concerns that you dont see listed on the form </label> </span> </div> </li> <li class="form-line" data-type="control_button" id="id_13"> <div id="cid_13" class="form-input-wide"> <div style="margin-left:156px" data-align="auto" class="form-buttons-wrapper form-buttons-auto jsTest-button-wrapperField"> <button id="input_13" type="submit" class="form-submit-button submit-button jf-form-buttons jsTest-submitField" data-component="button" data-content=""> Submit Form </button> </div> </div> </li> <li style="display:none"> Should be Empty: <input type="text" name="website" value="" /> </li> </ul> </div> <script> JotForm.showJotFormPowered = "new_footer"; </script> <script> JotForm.poweredByText = "Powered by JotForm"; </script> <input type="hidden" class="simple_spc" id="simple_spc" name="simple_spc" value="202666328230653" /> <script type="text/javascript"> var all_spc = 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