<form-template> <fields> <field type="text" subtype="text" required="true" label="Name" class="form-control text-input" name="text-1679587673003"></field> <field type="text" subtype="email" required="true" label="Email Address" class="form-control text-input" name="text-1679587673595"></field> <field type="text" subtype="text" required="true" label="Phone Number" class="form-control text-input" name="text-1679587675299"></field> <field type="date" label="Date" class="form-control calendar" name="date-1679587875699"></field> <field type="text" subtype="text" required="true" label="Property Address" class="form-control text-input" name="text-1679587676243"></field> <field type="text" subtype="text" label="Block" class="form-control text-input" name="text-1679587676739"></field> <field type="text" subtype="text" label="Lot" class="form-control text-input" name="text-1679587677235"></field> <field type="text" subtype="text" label="Qualifier" class="form-control text-input" name="text-1679587677667"></field> <field type="header" subtype="h3" label="New Mailing Address" class="header"></field> <field type="text" subtype="text" required="true" label="Address Line 1" class="form-control text-input" name="text-1679587686027"></field> <field type="text" subtype="text" label="Address Line 2" class="form-control text-input" name="text-1679587686355"></field> <field type="text" subtype="text" required="true" label="City" class="form-control text-input" name="text-1679587686674"></field> <field type="select" required="true" label="State" class="form-control select" name="select-1679587692059"> <option value="AK" selected="true">AK</option> <option value="AL">AL</option> <option value="AR">AR</option> <option value="AZ">AZ</option> <option value="CA">CA</option> <option value="CO">CO</option> <option value="CT">CT</option> <option value="DC">DC</option> <option value="DE">DE</option> <option value="FL">FL</option> <option value="GA">GA</option> <option value="HI">HI</option> <option value="IA">IA</option> <option value="ID">ID</option> <option value="IL">IL</option> <option value="IN">IN</option> <option value="KS">KS</option> <option value="KY">KY</option> <option value="LA">LA</option> <option value="MA">MA</option> <option value="MD">MD</option> <option value="ME">ME</option> <option value="MI">MI</option> <option value="MN">MN</option> <option value="MO">MO</option> <option value="MS">MS</option> <option value="MT">MT</option> <option value="NC">NC</option> <option value="ND">ND</option> <option value="NE">NE</option> <option value="NH">NH</option> <option value="NJ">NJ</option> <option value="NM">NM</option> <option value="NV">NV</option> <option value="NY">NY</option> <option value="OH">OH</option> <option value="OK">OK</option> <option value="OR">OR</option> <option value="PA">PA</option> <option value="RI">RI</option> <option value="SC">SC</option> <option value="SD">SD</option> <option value="TN">TN</option> <option value="TX">TX</option> <option value="UT">UT</option> <option value="VA">VA</option> <option value="VT">VT</option> <option value="WA">WA</option> <option value="WI">WI</option> <option value="WV">WV</option> <option value="WY">WY</option> </field> <field type="text" subtype="text" required="true" label="Zip Code" class="form-control text-input" name="text-1679587687075"></field> <field type="checkbox" required="true" label="I am the owner of the above property, or I have the express written permission of the owner to request this change to the mailing address." class="checkbox" name="checkbox-1679587702547"></field> </fields> </form-template> Submit Submitting...