|
| 1 | +% cascade base { title => 'Feedback form - Companies House service', disable_header_search => 1, user_bar => false, insights_bar => false, } |
| 2 | + |
| 3 | +% around content -> { |
| 4 | + |
| 5 | +<div id="feedback-received" class="no-script"> |
| 6 | + <h2 class="heading-medium">Thank you, your submission has been accepted</h2> |
| 7 | +</div> |
| 8 | + |
| 9 | +<div id="feedback-form-container"> |
| 10 | + <form action="/customer-feedback" class="form" enctype="" method="post" name="" id="feedback-form"> |
| 11 | + <input type="hidden" name="source_url" value="" id="source-url-field"> |
| 12 | + <div class="text"> |
| 13 | + <h1 class="heading" id="main">Help us improve the Companies House service</h1> |
| 14 | + </div> |
| 15 | + <div id="feedback-failed" class="no-script"> |
| 16 | + <p>Your submission has not been successful, please try again</p> |
| 17 | + </div> |
| 18 | + <fieldset> |
| 19 | + <legend class="visuallyhidden">Is there anything wrong with this page?</legend> |
| 20 | + <p><a href="https://www.gov.uk/stop-companies-house-from-publishing-your-address" target="_blank">Stop Companies House from publishing your address<span class="visuallyhidden">(link opens a new window)</span></a></p> |
| 21 | + <div class="form-group"> |
| 22 | + <label for="feedback-textarea" class="form-label"><strong>What is wrong with the page?</strong> |
| 23 | + <span class="form-hint">For example, information is missing or incorrect.</span></label> |
| 24 | + <textarea rows="5" maxlength="300" id="feedback-textarea" name="customer_feedback" cols="30" class="form-control" required></textarea> |
| 25 | + </div> |
| 26 | + <div class="form-group"> |
| 27 | + <label class="form-label" for="feedback-name"><strong>What is your name?</strong> (optional) </label> |
| 28 | + <input autocomplete="off" id ="feedback-name" class="form-control" name="customer_name" type="text" value=""> |
| 29 | + </div> |
| 30 | + <div class="form-group" style="display: none;"> |
| 31 | + <label class="form-label" for="feedback-check">confirmation</label> |
| 32 | + <input autocomplete="off" id ="feedback-check" name="customer_realcheck" type="text" value=""> |
| 33 | + </div> |
| 34 | + <div class="form-group"> |
| 35 | + <label class="form-label" for="feedback-email"><strong>What is your email address?</strong> (optional) </label> |
| 36 | + <input autocomplete="off" id="feedback-email" class="form-control" name="customer_email" type="email" value=""> |
| 37 | + </div> |
| 38 | + <div class="form-group" id="auth-form-group"> |
| 39 | + <label class="form-label" id="auth-code-label" for="feedback-auth"><strong>Enter these characters to prove you're not a robot </strong></label> |
| 40 | + <input autocomplete="off" id="feedback-auth" class="form-control form-control-1-8" required name="customer_auth" type="numbers" value=""> |
| 41 | + </div> |
| 42 | + <input type="submit" class="button" id="submit-report" value="Submit report"> |
| 43 | + </fieldset> |
| 44 | + </form> |
| 45 | +</div><!--toggle--> |
| 46 | +% } |
0 commit comments