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<form-template>
	<fields>
		<field class="header" label="Join for FREE Now" type="header" subtype="h2"></field>
		<field class="header" label="Your Details" type="header" subtype="h3"></field>
		<field class="form-control text-input" label="First name" name="first_name" required="true" type="text" subtype="text"></field>
		<field class="form-control text-input" label="Surname" name="surname" required="true" type="text" subtype="text"></field>
		<field class="form-control text-input" label="Email address" name="email_address" required="true" type="text" subtype="text"></field>
		<field class="form-control text-input" label="Company" name="company" required="true" type="text" subtype="text"></field>
		<field class="form-control select" label="Which sector?" name="retailer-sector" required="true" type="select">
			<option value="value">Please select</option>
			<option value="baby-children">Baby &amp; Children	</option>
			<option value="charity">Charity</option>
			<option value="electrical_appliances">Electrical &amp; Appliances</option>
			<option value="fashion">Fashion</option>
			<option value="food_drink">Food &amp; Drink</option>
			<option value="gifts">Gifts</option>
			<option value="health_beauty">Health &amp; Beauty</option>
			<option value="home_garden">Home &amp; Garden</option>
			<option value="leisure_fitness">Leisure &amp; Fitness</option>
			<option value="multi_department">Multi-department</option>
			<option value="office_supplies">Office Supplies</option>
			<option value="other">Other</option>
			<option value="pets_supplies">Pets / Supplies</option>
			<option value="toys">Toys</option>
			<option value="travel">Travel</option>
		</field>
		<field class="form-control text-input" label="Telephone" name="telephpne" required="true" type="text" subtype="text"></field>
		<field class="btn btn-default button-input" label="Join for FREE Now" name="joinforfreenow" type="button" subtype="submit"></field>
	</fields>
</form-template>

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