<h2>{global:formtitle}</h2>
{error}
<!-- Do not remove this ID, it is used to identify the page so that the pagination script can work correctly -->
<div class="formContainer formHorizontal formHidden" id="rsform_{global:formid}_page_0">
	<div class="formRow">
		<div class="formSpan12">
			<div class="rsform-block rsform-block-community-tv-application rsform-type-freetext{Community_TV_Application:errorClass}">
					{Community_TV_Application:body}
			</div>
		</div>
	</div>
	<div class="formRow">
		<div class="formSpan6">
			<div class="rsform-block rsform-block-merchant-name rsform-type-textbox{Merchant_Name:errorClass}">
				<label class="formControlLabel" for="Merchant_Name">{Merchant_Name:caption}</label>
				<div class="formControls">
					<div class="formBody">
						{Merchant_Name:body}
						<span class="formValidation">{Merchant_Name:validation}</span>
						<p class="formDescription">{Merchant_Name:description}</p>
					</div>
				</div>
			</div>
			<div class="rsform-block rsform-block-street-address rsform-type-textbox{Street_Address:errorClass}">
				<label class="formControlLabel" for="Street_Address">{Street_Address:caption}</label>
				<div class="formControls">
					<div class="formBody">
						{Street_Address:body}
						<span class="formValidation">{Street_Address:validation}</span>
						<p class="formDescription">{Street_Address:description}</p>
					</div>
				</div>
			</div>
			<div class="rsform-block rsform-block-city-or-town rsform-type-textbox{City_or_Town:errorClass}">
				<label class="formControlLabel" for="City_or_Town">{City_or_Town:caption}</label>
				<div class="formControls">
					<div class="formBody">
						{City_or_Town:body}
						<span class="formValidation">{City_or_Town:validation}</span>
						<p class="formDescription">{City_or_Town:description}</p>
					</div>
				</div>
			</div>
			<div class="rsform-block rsform-block-state-or-province rsform-type-textbox{State_or_Province:errorClass}">
				<label class="formControlLabel" for="State_or_Province">{State_or_Province:caption}</label>
				<div class="formControls">
					<div class="formBody">
						{State_or_Province:body}
						<span class="formValidation">{State_or_Province:validation}</span>
						<p class="formDescription">{State_or_Province:description}</p>
					</div>
				</div>
			</div>
			<div class="rsform-block rsform-block-business-phone rsform-type-phonenumber{Business_Phone:errorClass}">
				<label class="formControlLabel" for="Business_Phone">{Business_Phone:caption}</label>
				<div class="formControls">
					<div class="formBody">
						{Business_Phone:body}
						<span class="formValidation">{Business_Phone:validation}</span>
						<p class="formDescription">{Business_Phone:description}</p>
					</div>
				</div>
			</div>
			<div class="rsform-block rsform-block-store-logo rsform-type-fileupload{STORE_LOGO:errorClass}">
				<label class="formControlLabel" for="STORE_LOGO">{STORE_LOGO:caption}</label>
				<div class="formControls">
					<div class="formBody">
						{STORE_LOGO:body}
						<span class="formValidation">{STORE_LOGO:validation}</span>
						<p class="formDescription">{STORE_LOGO:description}</p>
					</div>
				</div>
			</div>
		</div>
		<div class="formSpan6">
			<div class="rsform-block rsform-block-website rsform-type-textbox{Website:errorClass}">
				<label class="formControlLabel" for="Website">{Website:caption}</label>
				<div class="formControls">
					<div class="formBody">
						{Website:body}
						<span class="formValidation">{Website:validation}</span>
						<p class="formDescription">{Website:description}</p>
					</div>
				</div>
			</div>
			<div class="rsform-block rsform-block-company-email rsform-type-textbox{Company_Email:errorClass}">
				<label class="formControlLabel" for="Company_Email">{Company_Email:caption}</label>
				<div class="formControls">
					<div class="formBody">
						{Company_Email:body}
						<span class="formValidation">{Company_Email:validation}</span>
						<p class="formDescription">{Company_Email:description}</p>
					</div>
				</div>
			</div>
			<div class="rsform-block rsform-block-business-contact rsform-type-textbox{Business_Contact:errorClass}">
				<label class="formControlLabel" for="Business_Contact">{Business_Contact:caption}</label>
				<div class="formControls">
					<div class="formBody">
						{Business_Contact:body}
						<span class="formValidation">{Business_Contact:validation}</span>
						<p class="formDescription">{Business_Contact:description}</p>
					</div>
				</div>
			</div>
			<div class="rsform-block rsform-block-contact-email rsform-type-textbox{Contact_Email:errorClass}">
				<label class="formControlLabel" for="Contact_Email">{Contact_Email:caption}<strong class="formRequired">(*)</strong></label>
				<div class="formControls">
					<div class="formBody">
						{Contact_Email:body}
						<span class="formValidation">{Contact_Email:validation}</span>
						<p class="formDescription">{Contact_Email:description}</p>
					</div>
				</div>
			</div>
			<div class="rsform-block rsform-block-contact-mobile rsform-type-textbox{Contact_Mobile:errorClass}">
				<label class="formControlLabel" for="Contact_Mobile">{Contact_Mobile:caption}</label>
				<div class="formControls">
					<div class="formBody">
						{Contact_Mobile:body}
						<span class="formValidation">{Contact_Mobile:validation}</span>
						<p class="formDescription">{Contact_Mobile:description}</p>
					</div>
				</div>
			</div>
		</div>
	</div>
	<div class="formRow">
		<div class="formSpan12">
			<div class="rsform-block rsform-block-cmptv-merchant-application-notes rsform-type-freetext{CMPTV_Merchant_Application_Notes:errorClass}">
					{CMPTV_Merchant_Application_Notes:body}
			</div>
			<div class="rsform-block rsform-block-number-of-community-tvs rsform-type-textbox{Number_of_Community_TVs:errorClass}">
				<label class="formControlLabel" for="Number_of_Community_TVs">{Number_of_Community_TVs:caption}</label>
				<div class="formControls">
					<div class="formBody">
						{Number_of_Community_TVs:body}
						<span class="formValidation">{Number_of_Community_TVs:validation}</span>
						<p class="formDescription">{Number_of_Community_TVs:description}</p>
					</div>
				</div>
			</div>
			<div class="rsform-block rsform-block-location-owner-agrees-to-basic rsform-type-checkboxgroup{Location_Owner_Agrees_to_Basic:errorClass}">
				<label class="formControlLabel" id="Location_Owner_Agrees_to_Basic-grouplbl">{Location_Owner_Agrees_to_Basic:caption}</label>
				<div class="formControls" role="group" aria-labelledby="Location_Owner_Agrees_to_Basic-grouplbl">
					<div class="formBody">
						{Location_Owner_Agrees_to_Basic:body}
						<span class="formValidation">{Location_Owner_Agrees_to_Basic:validation}</span>
						<p class="formDescription">{Location_Owner_Agrees_to_Basic:description}</p>
					</div>
				</div>
			</div>
		</div>
	</div>
	<div class="formRow">
		<div class="formSpan12">
			<div class="rsform-block rsform-block-cash-gift-cards rsform-type-pagebreak{Cash_Gift_Cards:errorClass}">
				<label class="formControlLabel" for="Cash_Gift_Cards">{Cash_Gift_Cards:caption}</label>
				<div class="formControls">
					<div class="formBody">
						{Cash_Gift_Cards:body}
					</div>
				</div>
			</div>
		</div>
	</div>
</div>
<!-- Do not remove this ID, it is used to identify the page so that the pagination script can work correctly -->
<div class="formContainer formHorizontal formHidden" id="rsform_{global:formid}_page_1">
	<div class="formRow">
		<div class="formSpan12">
			<div class="rsform-block rsform-block-what-are-give-back-gift-cards rsform-type-freetext{What_are_Give_Back_Gift_Cards:errorClass}">
					{What_are_Give_Back_Gift_Cards:body}
			</div>
			<div class="rsform-block rsform-block-free-download rsform-type-textbox{FREE_DOWNLOAD:errorClass}">
				<label class="formControlLabel" for="FREE_DOWNLOAD">{FREE_DOWNLOAD:caption}</label>
				<div class="formControls">
					<div class="formBody">
						{FREE_DOWNLOAD:body}
						<span class="formValidation">{FREE_DOWNLOAD:validation}</span>
						<p class="formDescription">{FREE_DOWNLOAD:description}</p>
					</div>
				</div>
			</div>
			<div class="rsform-block rsform-block-cash-gift-option-1 rsform-type-textbox{CASH_GIFT_OPTION_1:errorClass}">
				<label class="formControlLabel" for="CASH_GIFT_OPTION_1">{CASH_GIFT_OPTION_1:caption}</label>
				<div class="formControls">
					<div class="formBody">
						{CASH_GIFT_OPTION_1:body}
						<span class="formValidation">{CASH_GIFT_OPTION_1:validation}</span>
						<p class="formDescription">{CASH_GIFT_OPTION_1:description}</p>
					</div>
				</div>
			</div>
			<div class="rsform-block rsform-block-cash-gift-card-option-2 rsform-type-textbox{Cash_Gift_Card_Option_2:errorClass}">
				<label class="formControlLabel" for="Cash_Gift_Card_Option_2">{Cash_Gift_Card_Option_2:caption}</label>
				<div class="formControls">
					<div class="formBody">
						{Cash_Gift_Card_Option_2:body}
						<span class="formValidation">{Cash_Gift_Card_Option_2:validation}</span>
						<p class="formDescription">{Cash_Gift_Card_Option_2:description}</p>
					</div>
				</div>
			</div>
			<div class="rsform-block rsform-block-cash-gift-card-option-3 rsform-type-textbox{Cash_Gift_Card_Option_3:errorClass}">
				<label class="formControlLabel" for="Cash_Gift_Card_Option_3">{Cash_Gift_Card_Option_3:caption}</label>
				<div class="formControls">
					<div class="formBody">
						{Cash_Gift_Card_Option_3:body}
						<span class="formValidation">{Cash_Gift_Card_Option_3:validation}</span>
						<p class="formDescription">{Cash_Gift_Card_Option_3:description}</p>
					</div>
				</div>
			</div>
			<div class="rsform-block rsform-block-cash-gift-card-image rsform-type-fileupload{Cash_Gift_Card_Image:errorClass}">
				<label class="formControlLabel" for="Cash_Gift_Card_Image">{Cash_Gift_Card_Image:caption}</label>
				<div class="formControls">
					<div class="formBody">
						{Cash_Gift_Card_Image:body}
						<span class="formValidation">{Cash_Gift_Card_Image:validation}</span>
						<p class="formDescription">{Cash_Gift_Card_Image:description}</p>
					</div>
				</div>
			</div>
			<div class="rsform-block rsform-block-cash-gift-terms-and-conditions rsform-type-textarea{Cash_Gift_Terms_and_Conditions:errorClass}">
				<label class="formControlLabel" for="Cash_Gift_Terms_and_Conditions">{Cash_Gift_Terms_and_Conditions:caption}</label>
				<div class="formControls">
					<div class="formBody">
						{Cash_Gift_Terms_and_Conditions:body}
						<span class="formValidation">{Cash_Gift_Terms_and_Conditions:validation}</span>
						<p class="formDescription">{Cash_Gift_Terms_and_Conditions:description}</p>
					</div>
				</div>
			</div>
			<div class="rsform-block rsform-block-terms-and-conditions-cash-gifts rsform-type-freetext{Terms_and_Conditions_Cash_Gifts:errorClass}">
					{Terms_and_Conditions_Cash_Gifts:body}
			</div>
		</div>
	</div>
	<div class="formRow">
		<div class="formSpan12">
			<div class="rsform-block rsform-block-cash-gift-card-product-promotion rsform-type-pagebreak{Cash_Gift_Card_Product_Promotion:errorClass}">
				<label class="formControlLabel" for="Cash_Gift_Card_Product_Promotion">{Cash_Gift_Card_Product_Promotion:caption}</label>
				<div class="formControls">
					<div class="formBody">
						{Cash_Gift_Card_Product_Promotion:body}
					</div>
				</div>
			</div>
		</div>
	</div>
</div>
<!-- Do not remove this ID, it is used to identify the page so that the pagination script can work correctly -->
<div class="formContainer formHorizontal formHidden" id="rsform_{global:formid}_page_2">
	<div class="formRow">
		<div class="formSpan12">
			<div class="rsform-block rsform-block-promotion-name rsform-type-textbox{PROMOTION_NAME:errorClass}">
				<label class="formControlLabel" for="PROMOTION_NAME">{PROMOTION_NAME:caption}</label>
				<div class="formControls">
					<div class="formBody">
						{PROMOTION_NAME:body}
						<span class="formValidation">{PROMOTION_NAME:validation}</span>
						<p class="formDescription">{PROMOTION_NAME:description}</p>
					</div>
				</div>
			</div>
			<div class="rsform-block rsform-block-description-merchant-apply rsform-type-freetext{DESCRIPTION_MERCHANT_APPLY:errorClass}">
					{DESCRIPTION_MERCHANT_APPLY:body}
			</div>
			<div class="rsform-block rsform-block-description rsform-type-textarea{Description:errorClass}">
				<label class="formControlLabel" for="Description">{Description:caption}</label>
				<div class="formControls">
					<div class="formBody">
						{Description:body}
						<span class="formValidation">{Description:validation}</span>
						<p class="formDescription">{Description:description}</p>
					</div>
				</div>
			</div>
			<div class="rsform-block rsform-block-cash-gift-card-highlights rsform-type-textarea{Cash Gift Card Highlights:errorClass}">
				<label class="formControlLabel" for="Cash Gift Card Highlights">{Cash Gift Card Highlights:caption}</label>
				<div class="formControls">
					<div class="formBody">
						{Cash Gift Card Highlights:body}
						<span class="formValidation">{Cash Gift Card Highlights:validation}</span>
						<p class="formDescription">{Cash Gift Card Highlights:description}</p>
					</div>
				</div>
			</div>
			<div class="rsform-block rsform-block-summary rsform-type-textarea{Summary:errorClass}">
				<label class="formControlLabel" for="Summary">{Summary:caption}</label>
				<div class="formControls">
					<div class="formBody">
						{Summary:body}
						<span class="formValidation">{Summary:validation}</span>
						<p class="formDescription">{Summary:description}</p>
					</div>
				</div>
			</div>
		</div>
	</div>
	<div class="formRow">
		<div class="formSpan12">
			<div class="rsform-block rsform-block-give-back-rewards rsform-type-pagebreak{GIVE_BACK_REWARDS:errorClass}">
				<label class="formControlLabel" for="GIVE_BACK_REWARDS">{GIVE_BACK_REWARDS:caption}</label>
				<div class="formControls">
					<div class="formBody">
						{GIVE_BACK_REWARDS:body}
					</div>
				</div>
			</div>
		</div>
	</div>
</div>
<!-- Do not remove this ID, it is used to identify the page so that the pagination script can work correctly -->
<div class="formContainer formHorizontal formHidden" id="rsform_{global:formid}_page_3">
	<div class="formRow">
		<div class="formSpan12">
			<div class="rsform-block rsform-block-give-back-promotional-offer rsform-type-freetext{GIVE_BACK_PROMOTIONAL_OFFER:errorClass}">
					{GIVE_BACK_PROMOTIONAL_OFFER:body}
			</div>
			<div class="rsform-block rsform-block-agree-to-min-rewards rsform-type-checkboxgroup{AGREE_TO_MIN_REWARDS:errorClass}">
				<label class="formControlLabel" id="AGREE_TO_MIN_REWARDS-grouplbl">{AGREE_TO_MIN_REWARDS:caption}</label>
				<div class="formControls" role="group" aria-labelledby="AGREE_TO_MIN_REWARDS-grouplbl">
					<div class="formBody">
						{AGREE_TO_MIN_REWARDS:body}
						<span class="formValidation">{AGREE_TO_MIN_REWARDS:validation}</span>
						<p class="formDescription">{AGREE_TO_MIN_REWARDS:description}</p>
					</div>
				</div>
			</div>
			<div class="rsform-block rsform-block-authorize-rewards rsform-type-checkboxgroup{Authorize_Rewards:errorClass}">
				<label class="formControlLabel" id="Authorize_Rewards-grouplbl">{Authorize_Rewards:caption}</label>
				<div class="formControls" role="group" aria-labelledby="Authorize_Rewards-grouplbl">
					<div class="formBody">
						{Authorize_Rewards:body}
						<span class="formValidation">{Authorize_Rewards:validation}</span>
						<p class="formDescription">{Authorize_Rewards:description}</p>
					</div>
				</div>
			</div>
			<div class="rsform-block rsform-block-give-back-reward-gift-cards rsform-type-freetext{Give_Back_Reward_Gift_Cards:errorClass}">
					{Give_Back_Reward_Gift_Cards:body}
			</div>
			<div class="rsform-block rsform-block-authorized-to-approve-for-company rsform-type-checkboxgroup{Authorized_to_Approve_for_Company:errorClass}">
				<label class="formControlLabel" id="Authorized_to_Approve_for_Company-grouplbl">{Authorized_to_Approve_for_Company:caption}</label>
				<div class="formControls" role="group" aria-labelledby="Authorized_to_Approve_for_Company-grouplbl">
					<div class="formBody">
						{Authorized_to_Approve_for_Company:body}
						<span class="formValidation">{Authorized_to_Approve_for_Company:validation}</span>
						<p class="formDescription">{Authorized_to_Approve_for_Company:description}</p>
					</div>
				</div>
			</div>
{if {global:userid} == "0"}
			<div class="rsform-block rsform-block-captcha rsform-type-captcha{Captcha:errorClass}">
				<label class="formControlLabel" for="captchaTxt319">{Captcha:caption}<strong class="formRequired">(*)</strong></label>
				<div class="formControls">
					<div class="formBody">
						{Captcha:body}
						<span class="formValidation">{Captcha:validation}</span>
						<p class="formDescription">{Captcha:description}</p>
					</div>
				</div>
			</div>
{/if}
			<div class="rsform-block rsform-block-submit rsform-type-submitbutton{SUBMIT:errorClass}">
				<label class="formControlLabel">{SUBMIT:caption}</label>
				<div class="formControls">
					<div class="formBody">
						{SUBMIT:body}
						<span class="formValidation">{SUBMIT:validation}</span>
						<p class="formDescription">{SUBMIT:description}</p>
					</div>
				</div>
			</div>
		</div>
	</div>
</div>