Back to Layouts List

Council Tax Online Payments

Form 4

Step 4 of 5

Enter your details

if you're paying council tax for a business property
Previous
<h2 class="progress">Step 4 of 5</h2>

<h1 class="heading-large">Enter your details</h1>

<form action="form_5" method="post">
<div class="content-block">

    <div class="form-group">
        <label class="form-label-bold" for="FirstName">First name</label>
        <input class="form-control" type="text" id="FirstName" name="FirstName" data-val="true" data-val-requiredif="Enter first name " data-val-requiredif-dependentproperty="OrganisationName" data-val-requiredif-operator="EqualTo" data-val-requiredif-targetvalue="">
    </div>

    <div class="form-group">
        <label class="form-label-bold" for="LastName">Last name</label>
        <input class="form-control" type="text" id="LastName" name="LastName" data-val="true" data-val-requiredif="Enter last name " data-val-requiredif-dependentproperty="FirstName" data-val-requiredif-operator="NotEqualTo" data-val-requiredif-targetvalue="">
    </div>

    <div class="form-group">
        <label class="form-label-bold" for="OrganisationName">Organisation name <span class="unbold">(if applicable)</span> </label>
        <span class="form-hint">if you're paying council tax for a business property</span>
        <input class="form-control" type="text" id="OrganisationName" name="OrganisationName" data-val="true" data-val-requiredif="Enter organisation name " data-val-requiredif-dependentproperty="FirstName" data-val-requiredif-operator="EqualTo" data-val-requiredif-targetvalue="">
    </div>

    <div class="form-group">
        <label class="form-label-bold" for="email">Email address <span class="unbold">(optional)</span></label>
        <input class="form-control" type="text" id="email" name="email"  data-val="true" data-val-email="Enter a valid email address">
    </div>

     <div class="form-group">
        <label class="form-label-bold" for="email2">Retype email address</label>
        <input class="form-control" type="text" id="email2" name="email2" data-val="true" data-val-email="Enter a valid email address" data-val-equalto="Email addresses don&#39;t match" data-val-equalto-other="*.EmailAddress" id="RetypeEmailAddress" name="RetypeEmailAddress">
    </div>

    <fieldset class="postcode-search">
        <legend class="hidden">Postcode Search</legend>
        <div class="form-group">
            <label class="form-label-bold" for="postcode">What is your billing address?</label>
            <input class="form-control half-width" id="postcode" type="text"  data-uppercase data-postcode-search="search_term" data-val="true" data-val-required="You must enter a billing address">

            <p class="postcode-term-change js-hidden" data-postcode-search="postcode_term_change">
                <b data-postcode-search="postcode_term"></b>
                <button  type="button" class="text-button" data-postcode-search="change">Change</button>
            </p>

            <div class="js-hidden" data-postcode-search="results">

                <div class="form-select">
                    <select class="form-select" name="postcode" id="postcode" data-val="true" data-val-required="You must choose a billing address"></select>
                    <span class="arrow"></span>
                </div>

                <input type="hidden" name="result-saontext" data-result="saontext">
                <input type="hidden" name="result-paontext" data-result="paontext">
                <input type="hidden" name="result-paonrange" data-result="paonrange">
                <input type="hidden" name="result-streetname" data-result="streetname">
                <input type="hidden" name="result-locality" data-result="locality">
                <input type="hidden" name="result-town" data-result="town">
                <input type="hidden" name="result-county" data-result="county">
                <input type="hidden" name="result-postcode" data-result="postcode">
                <input type="hidden" name="result-uprn" data-result="uprn">
                <input data-result="ismedwayaddress" id="Address_IsMedwayAddress" name="Address.IsMedwayAddress" type="hidden" value="">
            </div>

            <div class="js-hidden" data-postcode-search="fallback">
                <p class="indent-error-message">Please type your address below.</p>

                <div class="form-group">
                    <label for="building-and-street" class="form-label-bold">Building and street</label>
                    <input class="form-control"
                    data-address="building-and-street"
                    data-val="true"
                    data-val-requiredif="Building and street"
                    data-val-requiredif-dependentproperty="Address_IsMedwayAddress"
                    data-val-requiredif-operator="EqualTo"
                    data-val-requiredif-targetvalue="true"
                    id="Address_Address1" name="Address.Address1" type="text" value="">
                    <input class="form-control" data-address="address2" id="Address_Address2" name="Address.Address2" type="text" value="">
                </div>

                <div class="form-group">
                    <label for="town-or-city" class="form-label-bold">Town or city</label>
                    <input type="text" class="form-control" id="town-or-city" name="town-or-city" data-address="town-or-city" data-val="true" data-val-required="Enter town or city" >
                </div>

                <div class="form-group">
                    <label for="county" class="form-label-bold">County <span class="unbold">(optional)</span></label>
                    <input type="text" class="form-control" id="county" name="county" data-address="county" id="Address_County" name="Address.County">
                </div>

                <div class="form-group">
                    <label for="postcode" class="form-label-bold">Postcode</label>
                    <input type="text" class="form-control" id="postcode" name="postcode" data-address="postcode" data-val="true" data-val-required="The Postcode field is required." >
                </div>
            </div>
        </div>

        <div class="form-group" data-postcode-search="button">
            <button class="button">Search for address</button>
        </div>
    </fieldset>

    <div class="form-step-buttons">
        <a href="form_3" class="button">Previous</a>
        <button type="submit" class="button">Continue</button>
    </div>

</div>
</form>