[ { "displayName": "Last 4 of SSN Account Holder", "type": "text", "schemaName": "last4ssn", "instructions": "", "help": "", "required": true }, { "displayName": "Regular Trash Collection Day", "type": "radio", "options": [ { "schemaName": "mon", "displayName": "Monday" }, { "schemaName": "tue", "displayName": "Tuesday" }, { "schemaName": "wed", "displayName": "Wednesday" }, { "schemaName": "thu", "displayName": "Thursday" } ], "schemaName": "pickupday", "instructions": "", "help": "", "required": true }, { "displayName": "Container Needing to be Repaired", "type": "radio", "options": [ { "schemaName": "96trash", "displayName": "96 Gallon Trash Container" }, { "schemaName": "48trash", "displayName": "48 Gallon Trash Container" }, { "schemaName": "96yard", "displayName": "96 Gallon Yard Waste Container" }, { "schemaName": "48yard", "displayName": "48 Gallon Yard Waste Container" } ], "schemaName": "containertype", "instructions": "", "help": "", "required": true }, { "displayName": "Reason for Repair?", "type": "radio", "options": [ { "schemaName": "lid", "displayName": "Lid broken or missing" }, { "schemaName": "wheels", "displayName": "Wheels broken or missing" }, { "schemaName": "bar", "displayName": "Bar missing" }, { "schemaName": "tote", "displayName": "Tote body damage" } ], "schemaName": "repairreason", "instructions": "", "help": "", "required": true }, { "displayName": "Comments or questions?", "type": "textarea", "schemaName": "comments", "instructions": "", "help": "", "required": false } ]