{exp:freeform:form 
	form_name="{stash:form_name}"
	form:class="sky-form"
	inline_errors="yes"
	inline_error_return="support/forms/{stash:form_name}/"
	required="name|address-line1|city|state|postal-code|email|product_model|product_serial|date"}
	
	{exp:snaptcha:field}
	{exp:subscriber:form form_id="1"}
	{freeform:field:unique_hash}
	<input type="hidden" name="return" value="support/forms/{stash:form_name}/thank-you/{csrf_token}" />
	
	<header>Tell Us About You</header>
	<fieldset>
		<section>
			<label class="label">{freeform:label:name}</label>
			<label class="input{if freeform:error:name} state-error{/if}">
				{freeform:field:name}
			</label>
			{if freeform:error:name}
				<div class="note note-error">Enter your name.</div>
			{/if}
		</section>
		
		<section>
			<label class="label">{freeform:label:organization}</label>
			<label class="input">
				{freeform:field:organization}
			</label>
		</section>
		
		<section>
			<label class="label">{freeform:label:address-line1}</label>
			<label class="input{if freeform:error:address-line1} state-error{/if}">
				{freeform:field:address-line1}
			</label>
			{if freeform:error:address-line1}
				<div class="note note-error">Enter a street address.</div>
			{/if}
		</section>
		
		<div class="row">
			<section class="col col-3">
				<label class="label">{freeform:label:city}</label>
				<label class="input{if freeform:error:city} state-error{/if}">
					{freeform:field:city}
				</label>
				{if freeform:error:city}
					<div class="note note-error">Enter a city.</div>
				{/if}
			</section>
			
			<section class="col col-3">
				<label class="label">{freeform:label:state}</label>
				<label class="input{if freeform:error:state} state-error{/if}">
					{freeform:field:state}
				</label>
				{if freeform:error:state}
					<div class="note note-error">Select a state.</div>
				{/if}
			</section>
			
			<section class="col col-3">
				<label class="label">{freeform:label:postal-code}</label>
				<label class="input{if freeform:error:postal-code} state-error{/if}">
					{freeform:field:postal-code}
				</label>
				{if freeform:error:postal-code}
					<div class="note note-error">Enter a ZIP/Postal Code.</div>
				{/if}
			</section>
			
			<section class="col col-3">
				<label class="label">{freeform:label:country}</label>
				<label class="input">
					{freeform:field:country}
				</label>
			</section>
		</div> {!-- end .row --}
		
		<div class="row">
			<section class="col col-4">
				<label class="label">{freeform:label:email}</label>
				<label class="input{if freeform:error:email} state-error{/if}">
					{freeform:field:email}
				</label>
				{if freeform:error:email}
					<div class="note note-error">Enter an email address.</div>
				{/if}
			</section>
			
			<section class="col col-4">
				<label class="label">Telephone</label>
				<label class="input">
					{freeform:field:tel}
				</label>
			</section>
			
			<section class="col col-4">
				<label class="label">{freeform:label:fax}</label>
				<label class="input">
					{freeform:field:fax}
				</label>
			</section>
		</div> {!-- end .row --}
	</fieldset>
	
	<header>Tell Us About Your Purchase</header>
	<fieldset>
		<div class="row">
			<section class="col col-4">
				<label class="label">{freeform:label:product_model}</label>
				<label class="input{if freeform:error:product_model} state-error{/if}">
					{freeform:field:product_model}
				</label>
				{if freeform:error:product_model}
					<div class="note note-error">Enter a product model.</div>
				{/if}
			</section>
			
			<section class="col col-4">
				<label class="label">{freeform:label:product_serial}</label>
				<label class="input{if freeform:error:product_serial} state-error{/if}">
					{freeform:field:product_serial}
				</label>
				{if freeform:error:product_serial}
					<div class="note note-error">Enter a serial number.</div>
				{/if}
			</section>
			
			<section class="col col-4">
				<label class="label">Purchase Date</label>
				<label class="input{if freeform:error:date} state-error{/if}">
					<i class="icon-append fa fa-calendar"></i>
					{freeform:field:date attr:id="date"}
				</label>
				{if freeform:error:date}
					<div class="note note-error">Select a purchase date.</div>
				{/if}
			</section>
		</div> {!-- end .row --}
	</fieldset>
	
	<footer>
		{freeform:submit attr:class="btn-u btn-large btn-u-default"}
	</footer>
	
{/exp:freeform:form}