{"template": "\n<div class=\"row\">\n\t<div class=\"col-sm-12\">\n\t\t\n\t\t\t<p>We want to hear about your experiences of using our services and we welcome feedback. Please use the box below to give us your feedback:</p>\n\t\t\t<form action=\"/help/want-to-give-feedback\" method=\"post\" accept-charset=\"utf-8\"><input type=\"hidden\" name=\"csrfmiddlewaretoken\" value=\"LnzBSeDoSjl53EUOrN8U2h6Yg2HgiQ0RPheQLk3qJuwnzxFqWj98mnk2fC1zeW1G\">\n\t\t\t\t<div class=\"row\">\n\t\t\t\t\t<div class=\"col-sm-12\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t<div class=\"form-group required\">\n\t\t\t\t\t\t\t\t<label class=\"control-label\">\n\t\t\t\t\t\t\t\t\tMessage\n\t\t\t\t\t\t\t\t</label>\n\t\t\t\t\t\t\t\t<textarea name=\"message\" cols=\"40\" rows=\"10\" maxlength=\"1500\" class=\"form-control\" required id=\"id_message\">\n</textarea>\n\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t</div>\n\t\t\t\t\t\t\n\t\t\t\t\t</div>\n\t\t\t\t</div>\n\n\t\t\t\t\n\t\t\t\t\t<div class=\"row\">\n\t\t\t\t\t\t<div class=\"col-sm-12\">\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t<div class=\"form-group required\">\n\t\t\t\t\t\t\t\t\t<label class=\"control-label\">\n\t\t\t\t\t\t\t\t\t\tFor response to your feedback, please provide your email address\n\t\t\t\t\t\t\t\t\t</label>\n\t\t\t\t\t\t\t\t\t<input type=\"email\" name=\"email\" maxlength=\"254\" required id=\"id_email\">\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t</div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t</div>\n\t\t\t\t\t</div>\n\t\t\t\t\n\t\t\t\t<input type=\"submit\" value=\"Send\" class=\"btn btn-lg btn-block btn-outline-secondary margin-top-15\">\n\t\t\t</form>\n\t\t\n\t</div>\n</div>"}