Payment Received Form, RCMP Criminal Record Check

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Payment Received Form, RCMP Criminal Record Check

<form-template>
	<fields>
		<field type="checkbox-group" required="true" label="Payment received:" class="checkbox-group" name="checkbox-group-1680713229515">
			<option value=" Criminal Record Check—$40 payable to the Town of Didsbury" selected="true">	Criminal Record Check—$40 payable to the Town of Didsbury</option>
			<option value=" Fingerprinting—$25 payable to the Town of Didsbury (Note: an additional $25 is payable to Receiver General, at the RCMP station)">	Fingerprinting—$25 payable to the Town of Didsbury (Note: an additional $25 is payable to Receiver General, at the RCMP station)</option>
		</field>
		<field type="text" subtype="text" required="true" label="Total Ampount:" description="Total amount paid" placeholder="$" class="form-control text-input" name="text-1680713316142"></field>
		<field type="text" subtype="text" required="true" label="Name:" placeholder="First and last name" class="form-control text-input" name="text-1680713383251"></field>
		<field type="textarea" required="true" label="Mailing address:" class="form-control text-area" name="textarea-1680713435127"></field>
		<field type="textarea" label="Email address:" class="form-control text-area" name="textarea-1680713468110"></field>
		<field type="radio-group" required="true" label="Receipt Options:" class="radio-group" name="radio-group-1680713571947">
			<option value=" Yes, I would like a receipt for my payment" selected="true">	Yes, I would like a receipt for my payment</option>
			<option value=" No, I do not require a receipt for my payment">	No, I do not require a receipt for my payment</option>
		</field>
		<field type="radio-group" label="If you require a receipt for your payment:" class="radio-group" name="radio-group-1680713671003">
			<option value=" I would like to have my receipt emailed to me at the above email address" selected="true">	I would like to have my receipt emailed to me at the above email address</option>
			<option value=" I would like to have my receipt mailed to me at the above mailing address">	I would like to have my receipt mailed to me at the above mailing address</option>
		</field>
		<field type="radio-group" required="true" label="Payment options:" class="radio-group" name="radio-group-1680713664573">
			<option value="Cash, paid in-person at the Didsbury RCMP station" selected="true">Cash, paid in-person at the Didsbury RCMP station</option>
			<option value="Debit, paid in-person at the Didsbury RCMP station">Debit, paid in-person at the Didsbury RCMP station</option>
			<option value="Credit, paid in-person at the Didsbury RCMP station">Credit, paid in-person at the Didsbury RCMP station</option>
			<option value="E-transfer to finance@didsbury.ca">E-transfer to finance@didsbury.ca</option>
			<option value=" Cheque, made to the Town of Didsbury (drop off at the Town Office at 1606 14 Street, or mail to Box 790)">	Cheque, made to the Town of Didsbury (drop off at the Town Office at 1606 14 Street, or mail to Box 790)</option>
		</field>
		<field type="textarea" label="ACCESS TO INFORMATION &amp;amp; PROTECTION OF PRIVACY" placeholder="All of the personal information provided on this form to the Town of Didsbury is collected under the authority of section 4 of the Alberta Protection of Privacy Act (POP) for the purpose of administering utilities. If you have any questions about the collection, use, or disclosure of this personal information, please contact the Town of Didsbury Access to Information and Protection of Privacy Coordinator at 403-335-3391 or aipp@didsbury.ca." class="form-control text-area" name="textarea-1761250765245"></field>
	</fields>
</form-template>