[ { "displayName": "Last 4 of SSN Account Holder", "type": "text", "schemaName": "last4ssn", "instructions": "", "help": "", "required": true }, { "displayName": "Regular Trash Pickup Day", "type": "radio", "options": [ { "schemaName": "mon", "displayName": "Monday" }, { "schemaName": "tue", "displayName": "Tuesday" }, { "schemaName": "wed", "displayName": "Wednesday" }, { "schemaName": "thur", "displayName": "Thursday" } ], "schemaName": "pickupday", "instructions": "", "help": "", "required": true }, { "displayName": "Bin Size", "type": "radio", "options": [ { "schemaName": "48gal", "displayName": "48 Gallon" }, { "schemaName": "96gal", "displayName": "96 Gallon" } ], "schemaName": "binSize", "instructions": "", "help": "", "required": true }, { "displayName": "Number of Bins Requested", "type": "number", "step": "1", "max": "", "min": "", "schemaName": "numberBins", "undefined": "1", "instructions": "", "help": "", "required": true }, { "displayName": "Reason for Trash Bin Request", "type": "radio", "options": [ { "schemaName": "moved", "displayName": "Recently Moved In/New Tenant - $10 Fee" }, { "schemaName": "stolen", "displayName": "Stolen/Lost - $50 Fee" }, { "schemaName": "upsize", "displayName": "Upsize to a Larger Bin - No Fee" }, { "schemaName": "downsize", "displayName": "Downsize to a Smaller Bin - No Fee" }, { "schemaName": "additional", "displayName": "Additional Bin - $8.58 added to monthly bill" }, { "schemaName": "damaged", "displayName": "Damaged - $50 Fee unless damaged by City" } ], "schemaName": "requestReason", "instructions": "", "help": "", "required": true }, { "displayName": "Any comments or questions?", "type": "textarea", "schemaName": "comments", "instructions": "", "help": "", "required": false } ]