
       
        <div id="REQUEST" class="Section">
 
            <div id="_TITLE" class="SectionHeader"><span class="SectionHeaderTitle">Request</span></div>   
 
               <div class="Fields">
               
                    <div class="Field" id="_ROW">
                        <div class="FieldCaption"><label class="FieldCaptionLabel" for="_FIRSTNAME">First name:</label></div>
                        <div class="FieldValue"><span class="FieldValueInput FieldValueInputReadonly" id="_FIRSTNAME" title="First name"></span></div>
                    </div>
               
                    <div class="Field" id="_ROW">
                        <div class="FieldCaption"><label class="FieldCaptionLabel" for="_LASTNAME">Last name:</label></div>
                        <div class="FieldValue"><span class="FieldValueInput FieldValueInputReadonly" id="_LASTNAME" title="Last name"></span></div>
                    </div>
               
                    <div class="Field" id="_ROW">
                        <div class="FieldCaption"><label class="FieldCaptionLabel" for="_DATE">Date:</label></div>
                        <div class="FieldValue"><span class="FieldValueInput FieldValueInputReadonly" id="_DATE" fielddatatype="DateTime" fieldformat="{0:d}" title="Date"></span></div>
                    </div>
               
                    <div class="Field" id="_ROW">
                        <div class="FieldCaption"><label class="FieldCaptionLabel" for="_CATEGORY">Category:</label></div>
                        <div class="FieldValue">
                            <select class="FieldValueInput" id="_CATEGORY" title="Category">
                                <option value="Category 1">Category 1</option>
                                <option value="Category 2">Category 2</option>
                                <option value="Category 3">Category 3</option>
                            </select>
                        </div>
                    </div>

                    <div class="Field" id="_ROW">
                        <div class="FieldCaption"><label class="FieldCaptionLabel" for="_SUBJECT">Subject:</label></div>
                        <div class="FieldValue"><input type="text" class="FieldValueInput" id="_SUBJECT" title="Subject"></input></div>
                    </div>
                
                    <div class="Field" id="_ROW">
                        <div class="FieldCaption"><label class="FieldCaptionLabel" for="_DESCRIPTION">Description:</label></div>
                        <div class="FieldValue"><textarea class="FieldValueInput" id="_DESCRIPTION" title="Description" rows="5"></textarea></div>
                    </div>
            
             </div>

        </div>
