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<!-- NOTE: Please add the following <META> element to your page <HEAD>. -->
<!-- If necessary, please modify the charset parameter to specify the -->
<!-- character set of your HTML page. -->
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<META HTTP-EQUIV="Content-type" CONTENT="text/html; charset=UTF-8">
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<!-- NOTE: Please add the following <FORM> element to your page. -->
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<form action="https://rdg--uat.my.salesforce.com/servlet/servlet.WebToCase?encoding=UTF-8" method="POST">
<input type=hidden name="orgid" value="00D1q0000008ecH">
<input type=hidden name="retURL" value="http://">
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<!-- NOTE: These fields are optional debugging elements. Please uncomment -->
<!-- these lines if you wish to test in debug mode. -->
<!-- <input type="hidden" name="debug" value=1> -->
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<label for="name">Contact Name</label><input id="name" maxlength="80" name="name" size="20" type="text" value="Ryan Kendrick" /><br>
<label for="email">Email</label><input id="email" maxlength="80" name="email" size="20" type="text" value"
[email protected]" /><br>
<label for="phone">Phone</label><input id="phone" maxlength="40" name="phone" size="20" type="text" value="01793 719617" /><br>
Railcard Type:<select id="00N1t00000LJwb9" name="00N1t00000LJwb9" title="Railcard Type"><option value="">--None--</option><option value="16 - 25 Railcard">16 - 25 Railcard</option>
<option value="26 - 30 Railcard">26 - 30 Railcard</option>
<option value="Disabled Persons Railcard">Disabled Persons Railcard</option>
<option value="Family & Friends Railcard">Family & Friends Railcard</option>
<option value="Network Railcard">Network Railcard</option>
<option value="Santander Railcard">Santander Railcard</option>
<option value="Senior Railcard">Senior Railcard</option>
<option value="Two Together Railcard">Two Together Railcard</option>
<option value="All Railcards">All Railcards</option>
</select><br>
Case Type:<select id="00N1t00000LJwb8" name="00N1t00000LJwb8" title="Case Type"><option value="">--None--</option><option value="Complaint">Complaint</option>
<option value="Enquiry">Enquiry</option>
<option value="Buy">Buy</option>
<option value="Renew">Renew</option>
<option value="Replace">Replace</option>
<option value="Data Change">Data Change</option>
<option value="Thank You">Thank You</option>
<option value="Refund">Refund</option>
<option value="GDPR request">GDPR request</option>
<option value="Other">Other</option>
</select><br>
Area:<select id="00N1t00000LJwb7" name="00N1t00000LJwb7" title="Area"><option value="">--None--</option><option value="Buying">Buying</option>
<option value="Eligibility">Eligibility</option>
<option value="Enquiry">Enquiry</option>
<option value="Renewing">Renewing</option>
<option value="Validity">Validity</option>
<option value="Customer error">Customer error</option>
<option value="Marketing">Marketing</option>
<option value="Stations">Stations</option>
<option value="Website">Website</option>
<option value="For me">For me</option>
<option value="For someone else">For someone else</option>
<option value="For me and someone else">For me and someone else</option>
<option value="Refunds">Refunds</option>
<option value="Replacements">Replacements</option>
<option value="Using">Using</option>
<option value="Customer">Customer</option>
<option value="Digital railcard">Digital railcard</option>
<option value="Lost">Lost</option>
<option value="Stolen">Stolen</option>
<option value="Damaged">Damaged</option>
<option value="Faded">Faded</option>
<option value="Customer problems">Customer problems</option>
<option value="Railcard terms and conditions">Railcard terms and conditions</option>
<option value="Bought wrong Railcard">Bought wrong Railcard</option>
<option value="No longer required">No longer required</option>
<option value="Rejected eligibility">Rejected eligibility</option>
<option value="I bought it at the station instead">I bought it at the station instead</option>
<option value="I couldn't upload a photograph">I couldn't upload a photograph</option>
<option value="Wrong details entered">Wrong details entered</option>
<option value="I had already renewed">I had already renewed</option>
<option value="Didn't arrive in post">Didn't arrive in post</option>
<option value="Update personal details">Update personal details</option>
<option value="Update photograph">Update photograph</option>
<option value="Subject access request">Subject access request</option>
<option value="Delete my details">Delete my details</option>
<option value="Unsubscribe me from marketing">Unsubscribe me from marketing</option>
<option value="Stop processing my data">Stop processing my data</option>
<option value="Customer service response">Customer service response</option>
<option value="Railcard service">Railcard service</option>
<option value="Other">Other</option>
</select><br>
<label for="subject">Subject</label><input id="subject" maxlength="80" name="subject" size="20" type="text" value="This is a test." /><br>
<label for="description">Description</label><textarea name="description">This is a test for the purposes of testing.</textarea><br>
<input type="submit" name="submit">
</form>