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<div class="row"> <div class="col-10 offset-1"> <div class="mb-3"> <label for="fName" class="form-label">First name:</label> <input type="text" class="form-control tmblk" id="fName" aria-describedby="fName" maxlength="50" placeholder="First name"> </div> </div> </div> <div class="row"> <div class="col-10 offset-1"> <div class="mb-3"> <label for="lName" class="form-label">Last name:</label> <input type="text" class="form-control tmblk" id="lName" aria-describedby="lName" maxlength="50" placeholder="Last name"> </div> </div> </div> <div class="row"> <div class="col-10 offset-1"> <div class="mb-3"> <label for="email" class="form-label">Email:</label> <input type="text" class="form-control tmblk" id="email" aria-describedby="email" placeholder="Email address"> </div> </div> </div> <div class="row"> <div class="col-10 offset-1"> <div class="mb-3"> <label for="phoneNum" class="form-label">Phone number:</label> <input type="tel" class="form-control tmblk" id="phoneNum" aria-describedby="phoneNum" placeholder="xxx-xxx-xxxx" data-inputmask="'mask': '999-999-9999'"> </div> </div> </div> <hr /> <div class="row"> <div class="col-10 offset-1"> <label for="meetinginfo" class="form-label"> This will reserve the selected time slot: </label> <div id="meetinginfo" class="fs-5">-_-MI-_-</div> <div id="meetingmaps"><a href="https://goo.gl/maps/-_-MA-_-" target="_blank">-_-LO-_-</a></div> </div> </div> <div class="row w-100"> <div class="btn-group" role="group"> <button type="button" id="btnSchedBook" onclick="reCaptchaCheck(this);" data-qt="-_-QT-_-" data-ts="-_-TS-_-" data-ld="-_-LD-_-" data-lo="-_-LO-_-" data-ma="-_-MA-_-" class="btn btn-outline-primary" disabled>Secure Appointment</button> <button type="button" id="btnSchedCancel" onclick="modalPopup();" class="btn btn-success">Cancel</button> </div> </div> <div class="row"> <div class="col-12"> Thanks! Your appointment has been reserved for -_-LD-_- at <br /> <a href="https://goo.gl/maps/-_-MA-_-" target="_blank">-_-LO-_-</a> <br /> <br /> Your confirmation code is <span class="fw-bold">-_-CO-_-</span> <br /> <br /> For information on services and what to bring, please visit us at <a href="https://www.vctaxcollector.org">https://www.vctaxcollector.org</a> </div> </div> <a class="btn btn-primary" href="https://vctaxcollector.org" target="_parent" role="button" onclick="modalPopup();">Close</a>