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- <div id="submit-page" class="wrapper" data-role="page" data-add-back-btn="true">
- <div id="submit-header" data-role="header" data-position="fixed" data-id="locate">
- <h1>Submit</h1>
- </div>
-
- <div class="container" data-role="content" data-enhance="false">
- <div class="content" role="main">
-
- <form action="" method="post" name="mapForm" id="mapForm" enctype="multipart/form-data" class="validate" data-ajax="false">
-
- <fieldset>
- <div id="problem_form">
- <div id="signed_in">
- <p>
- You are signed in as <span id="username"></span>
- </p>
-
- <p id="confirm_details">Confirm details</p>
- <div id="name_details">
- <label for="form_may_show_name">Name</label>
- <input type="text" class="validName" value="" name="name" id="form_name" placeholder="Your name">
-
- <div class="checkbox-group">
- <input type="checkbox" name="may_show_name" id="form_may_show_name" value="1" checked>
- <label class="inline" for="form_may_show_name">Show my name publicly</label>
- </div>
-
- <label for="form_phone">Phone number</label>
- <input type="text" value="" name="phone" id="form_phone" placeholder="Your phone number (optional)">
- </div>
-
- <div class="form-txt-submit-box">
- <input class="green-btn" type="submit" id="submit_signed_in" name="submit_signed_in" value="Report">
- </div>
- </div>
-
- <div id="signed_out">
- <label for="form_email" id="email_label">Your email</label>
- <input type="email" value="" name="email" id="form_email" placeholder="Please enter your email address" required>
-
- <div id="form_sign_in">
- <h4 id="have_password">Do you have a FixMyStreet password?</h4>
-
- <div id="form_sign_in_yes" class="form-box">
-
- <h5><strong>Yes</strong> I have a password</h5>
-
- <label class="hidden-js n" for="password_sign_in">Yes I have a password</label>
- <div class="form-txt-submit-box">
- <input type="password" name="password_sign_in" id="password_sign_in" placeholder="Your password" value="">
- <input class="green-btn" type="submit" id="submit_sign_in" name="submit_sign_in" value="Report">
- </div>
- </div>
-
- <div id="form_sign_in_no" class="form-box">
- <h5 id="let_me_confirm"><strong>No</strong> Let me confirm my report by email</h5>
-
-
- <div id="password_surround">
- <label class="form-focus-hidden" for="password_register" id="password_label">Password</label>
- </div>
-
- <div class="form-txt-submit-box form-focus-hidden">
- <input type="password" name="password_register" id="password_register" value="" placeholder="Enter a password (optional)">
- <input class="green-btn" type="submit" id="submit_register" name="submit_register" value="Report">
- </div>
-
- </div>
- </div>
- </div>
-
- <div id="report_save" class="form-box">
- <h5>Save this report for completion later</h5>
- <div class="form-txt-submit-box">
- <input class="green-btn" type="button" id="save_report" name="save_report" value="Save">
- </div>
- </div>
- </div>
- </fieldset>
-
- <input type="hidden" name="submit_problem" value="1">
- </div>
-
- </div>
- </form>
- </div>
- </div>
- </div> <!-- .wrapper -->