Share your information with Heather Taylor

Heather Taylor

FunLovingTravels

<html>
  <body>
    <form-template>&#13;
	<fields><field type="text" subtype="text" required="true" label="Last name" className="form-control" name="last-name"></field><field type="text" subtype="text" required="true" label="Email" className="form-control" name="email"></field>&#13;
		<field type="header" subtype="h1" label="LEAVE US A REVIEW"/>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#13;
		<field type="text" required="true" label="Name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="date" label="When did you travel?" name="when-did-you-travel" className="form-control"/>&#13;
		<field type="radio-group" label="Rate us" name="rate-us">&#13;
			<option label="1" value="1">1</option>&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3" value="3">3</option>&#13;
			<option label="4" value="4">4</option>&#13;
			<option label="5" value="5">5</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Would you recommend us to others" name="would-you-recommend-us-to-others">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="textarea" label="Let us know anything about your services from us." name="let-us-know-anything-about-your-services-from-us" className="form-control"/>&#13;
		<field type="radio-group" label="Can we use your review on social Media?" name="can-we-use-your-review-on-social-media">&#13;
			<option label="yes" value="yes">yes</option>&#13;
			<option label="no" value="no">no</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>