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<html>
<head>
<title>Test Client</title>
<style></style>
</head>
<body>
<h1>Test Client</h1>
<h2>http://localhost/crm/open311/v2/requests.xml</h2>
<form method="post" action="http://localhost/crm/open311/v2/requests.xml">
<fieldset><legend>Ticket Info</legend>
<table>
<tr><th><label for="jurisdiction_id">Jurisdiction</label></th>
<td><input name="jurisdiction_id" id="jurisdiction_id" value="bloomington.in.gov" /></td>
</tr>
<tr><th><label for="api_key">api_key</label></th>
<td><input name="api_key" id="api_key" /></td>
</tr>
<tr><th><label for="service_code">Service Code</label></th>
<td><input name="service_code" id="service_code" value="" /></td>
</tr>
</table>
<div><label for="description">Description</label></div>
<div><textarea name="description" id="description">Test Report</textarea></div>
</fieldset>
<fieldset><legend>Personal Info</legend>
<table>
<tr><th><label for="first_name">first_name</label></th>
<td><input name="first_name" id="first_name" /></td>
</tr>
<tr><th><label for="last_name">last_name</label></th>
<td><input name="last_name" id="last_name" /></td>
</tr>
<tr><th><label for="phone">phone</label></th>
<td><input name="phone" id="phone" /></td>
</tr>
<tr><th><label for="device_id">device_id</label></th>
<td><input name="device_id" id="device_id" /></td>
</tr>
</table>
</fieldset>
<fieldset>
<input type="submit" value="Submit" />
</fieldset>
</form>
</body>
</html>