chrome/test/data/autofill/heuristics/input/bug_459132.html

   1 <form data-dojo-attach-point="containerNode" data-dojo-attach-event="onreset:_onReset,onsubmit:_onSubmit" name="FeedbackForm" lang="en" action="https://www.lufthansa.com/online/portal/lh/de/help_contact/feedback/!ut/p/c5/04_SB8K8xLLM9MSSzPy8xBz9CP0os3hHg2B_U3d350DfMA9jA0czF5OgUFNLC9MAU6B8JE75gAADYnQb4ACOhHR76Uel5-QnAV0ZDnI3bne4mOKXB7kTJI_HJX4e-bmp-gW5oRGVwZ66AI5DSgQ!/dl3/d3/L0lJSklna2tra2tra25wQSEvb013d0FBQVlnQUNFSVFRaUtVUXhnb1lCem5KUUZnQSEvNEJuNHNvMFZnTGE5Mmd6a0xLQnl3ZyEhLzZfQTBTTzVHR0NRTVZIMzBBNkQ0UlU1OTg1UDUvN19BMFNPNUdHQ1FNVkgzMEE2RDRSVTU5MEkwMS9zYS5GZWVkYmFja0lucHV0QWN0aW9uL25vcm1hbC9EZWZhdWx0/?l=en&amp;cid=18002&amp;action=FeedbackInputAction&amp;command=sumbitForm&amp;p=LH&amp;s=DE&amp;l=en&amp;cid=18002&amp;action=FeedbackInputAction&amp;command=sumbitForm&amp;p=LH&amp;s=DE" id="fb_form" method="post" widgetid="fb_form">
   2
   3     <!--  Hidden input to disable content header portlet-->
   4     <input type="hidden" name="formSubmitted" value="true">
   5     <input type="hidden" value="" name="formtype" id="formTypeInput">
   6     <input type="hidden" name="isFlynet" value="false">
   7     <input type="hidden" name="categoryId" id="categoryId" value="">
   8
   9     <div id="fb_mod_personal" class="lh_fbMargin clearfix">
  10   <div class="fieldwrapper wide">
  11     <h1>Your personal data</h1>
  12   </div>
  13   <span class="overwriteMessage">Please note that any changes will not be saved to your profile.</span>
  14
  15   <div class="subtpl">
  16     <div class="fieldwrapper">
  17       <label for="title" class="title">Title</label>
  18       <div id="title"><table class="dijit dijitReset dijitInline dijitLeft dijitDownArrowButton fb_protect title dijitSelect dijitValidationTextBox dijitSelectIncomplete dijitValidationTextBoxIncomplete dijitIncomplete" data-dojo-attach-point="_buttonNode,tableNode,focusNode,_popupStateNode" cellspacing="0" cellpadding="0" role="listbox" aria-haspopup="true" tabindex="0" id="lh_widget_form_KeySelect_0" aria-required="true" widgetid="lh_widget_form_KeySelect_0" aria-expanded="false" aria-invalid="true" style="-webkit-user-select: none;"><tbody role="presentation"><tr role="presentation"><td class="dijitReset dijitStretch dijitButtonContents" role="presentation"><div class="dijitReset dijitInputField dijitButtonText" data-dojo-attach-point="containerNode,textDirNode" role="presentation"><span role="option" class="dijitReset dijitInline dijitSelectLabel dijitValidationTextBoxLabel ">Please select</span></div><div class="dijitReset dijitValidationContainer"><input class="dijitReset dijitInputField dijitValidationIcon dijitValidationInner" value="Χ " type="text" tabindex="-1" readonly="readonly" role="presentation"></div><input type="hidden" name="Salutation_1" data-dojo-attach-point="valueNode" value=" " aria-hidden="true"></td><td class="dijitReset dijitRight dijitButtonNode dijitArrowButton dijitDownArrowButton dijitArrowButtonContainer" data-dojo-attach-point="titleNode" role="presentation"><input class="dijitReset dijitInputField dijitArrowButtonInner" value="▼ " type="text" tabindex="-1" readonly="readonly" role="presentation"></td></tr></tbody></table></div>
  19     </div>
  20   </div>
  21
  22   <div class="subtpl clear">
  23     <div class="cl">
  24       <div class="fieldwrapper">
  25         <label for="firstname" class="firstname">First name</label>
  26         <div id="firstname"><div class="dijit dijitReset dijitInline dijitLeft fb_protect firstname dijitTextBox dijitValidationTextBox dijitTextBoxError dijitValidationTextBoxError dijitError" id="widget_firstname" role="presentation" widgetid="firstname"><div class="dijitReset dijitValidationContainer"><input class="dijitReset dijitInputField dijitValidationIcon dijitValidationInner" value="Χ " type="text" tabindex="-1" readonly="readonly" role="presentation"></div><div class="dijitReset dijitInputField dijitInputContainer"><input class="dijitReset dijitInputInner" data-dojo-attach-point="textbox,focusNode" autocomplete="off" name="FirstName_1" type="text" tabindex="0" id="firstname" aria-required="true" maxlength="50" value="" aria-invalid="true"></div></div></div>
  27       </div>
  28     </div>
  29
  30     <div class="cl">
  31       <div class="fieldwrapper">
  32         <label for="lastname" class="lastname">Last name</label>
  33         <div id="lastname"><div class="dijit dijitReset dijitInline dijitLeft fb_protect lastname dijitTextBox dijitValidationTextBox dijitTextBoxIncomplete dijitValidationTextBoxIncomplete dijitIncomplete" id="widget_lastname" role="presentation" widgetid="lastname"><div class="dijitReset dijitValidationContainer"><input class="dijitReset dijitInputField dijitValidationIcon dijitValidationInner" value="Χ " type="text" tabindex="-1" readonly="readonly" role="presentation"></div><div class="dijitReset dijitInputField dijitInputContainer"><input class="dijitReset dijitInputInner" data-dojo-attach-point="textbox,focusNode" autocomplete="off" name="LastName_1" type="text" tabindex="0" id="lastname" aria-required="true" maxlength="50" value="" aria-invalid="false"></div></div></div>
  34       </div>
  35     </div>
  36   </div>
  37
  38   <div class="subtpl clear">
  39     <div class="cl">
  40       <div class="fieldwrapper">
  41         <label for="email" class="email">Email</label>
  42         <div id="email"><div class="dijit dijitReset dijitInline dijitLeft fb_protect email dijitTextBox dijitValidationTextBox dijitTextBoxIncomplete dijitValidationTextBoxIncomplete dijitIncomplete dijitTextBoxFocused dijitValidationTextBoxFocused dijitTextBoxIncompleteFocused dijitValidationTextBoxIncompleteFocused dijitIncompleteFocused dijitFocused" id="widget_email" role="presentation" widgetid="email"><div class="dijitReset dijitValidationContainer"><input class="dijitReset dijitInputField dijitValidationIcon dijitValidationInner" value="Χ " type="text" tabindex="-1" readonly="readonly" role="presentation"></div><div class="dijitReset dijitInputField dijitInputContainer"><input class="dijitReset dijitInputInner" data-dojo-attach-point="textbox,focusNode" autocomplete="off" name="Email_1" type="text" tabindex="0" id="email" aria-required="true" value="" aria-invalid="false"></div></div></div>
  43       </div>
  44     </div>
  45
  46     <div class="cl">
  47       <div class="fieldwrapper">
  48         <label for="r_email" class="email">Re-enter email</label>
  49         <div id="r_email"><div class="dijit dijitReset dijitInline dijitLeft dijitTextBox dijitValidationTextBox fb_protect email" id="widget_r_email" role="presentation" widgetid="r_email"><div class="dijitReset dijitValidationContainer"><input class="dijitReset dijitInputField dijitValidationIcon dijitValidationInner" value="Χ " type="text" tabindex="-1" readonly="readonly" role="presentation"></div><div class="dijitReset dijitInputField dijitInputContainer"><input class="dijitReset dijitInputInner" data-dojo-attach-point="textbox,focusNode" autocomplete="off" name="rEmail_1" type="text" tabindex="0" id="r_email" aria-required="true" value="" aria-invalid="false"></div></div></div>
  50       </div>
  51     </div>
  52
  53   </div>
  54
  55   <div class="subtpl clear">
  56     <div class="cl">
  57       <div class="fieldwrapper">
  58         <label for="mam_number" class="mam_number">Miles &amp; More number <span class="optional"><span>&nbsp;</span>optional</span></label>
  59         <div id="mam_number"><div class="dijit dijitReset dijitInline dijitLeft dijitTextBox dijitValidationTextBox fb_protect mam_number" id="widget_mam_number" role="presentation" widgetid="mam_number"><div class="dijitReset dijitValidationContainer"><input class="dijitReset dijitInputField dijitValidationIcon dijitValidationInner" value="Χ " type="text" tabindex="-1" readonly="readonly" role="presentation"></div><div class="dijitReset dijitInputField dijitInputContainer"><input class="dijitReset dijitInputInner" data-dojo-attach-point="textbox,focusNode" autocomplete="off" name="MamNumber_1" type="text" tabindex="0" id="mam_number" maxlength="15" value="" aria-invalid="false"></div></div></div>
  60       </div>
  61     </div>
  62   </div>
  63 </div>
  64     <div id="fb_mod_catSelector" class="lh_fbMargin clearfix">
  65   <div class="subtpl">
  66     <div class="cl w50  firstColumn">
  67       <h1>What can we do for you?</h1>
  68     <table class="dijit dijitReset dijitInline dijitLeft dijitDownArrowButton fb_protect cat_select1 dijitSelectFixedWidth dijitValidationTextBoxFixedWidth dijitSelect dijitValidationTextBox dijitSelectIncomplete dijitValidationTextBoxIncomplete dijitIncomplete" data-dojo-attach-point="_buttonNode,tableNode,focusNode,_popupStateNode" cellspacing="0" cellpadding="0" role="listbox" aria-haspopup="true" tabindex="0" id="CAT_SELECT_1" aria-required="true" widgetid="CAT_SELECT_1" aria-expanded="false" aria-invalid="true" style="-webkit-user-select: none; display: block; width: auto; font-size: 14px; padding: 1px 0px 1px 10px; margin: 10px 0px 0px;"><tbody role="presentation"><tr role="presentation"><td class="dijitReset dijitStretch dijitButtonContents" role="presentation"><div class="dijitReset dijitInputField dijitButtonText" data-dojo-attach-point="containerNode,textDirNode" role="presentation"><span role="option" class="dijitReset dijitInline dijitSelectLabel dijitValidationTextBoxLabel ">Please select a category</span></div><div class="dijitReset dijitValidationContainer"><input class="dijitReset dijitInputField dijitValidationIcon dijitValidationInner" value="Χ " type="text" tabindex="-1" readonly="readonly" role="presentation"></div><input type="hidden" name="Category_1" data-dojo-attach-point="valueNode" value=" " aria-hidden="true"></td><td class="dijitReset dijitRight dijitButtonNode dijitArrowButton dijitDownArrowButton dijitArrowButtonContainer" data-dojo-attach-point="titleNode" role="presentation"><input class="dijitReset dijitInputField dijitArrowButtonInner" value="▼ " type="text" tabindex="-1" readonly="readonly" role="presentation"></td></tr></tbody></table></div>
  69
  70     <div class="cr w50 secondColumn">
  71       <p class="x-hidden">
  72         <iframe src="" id="iInterceptor"></iframe>
  73       </p>
  74     </div>
  75   </div>
  76   <div class="selectorQuestion  fb_borderSeperator x-hidden clear"></div>
  77 </div>
  78
  79     <div id="fb_mod_dynamicWrapper" class="lh_fbMargin x-hidden">
  80       <h1>Please fill in more detailed information</h1>
  81
  82
  83       <div id="fb_mod_cstm_wrp" class="fb_borderSeperator x-hidden">
  84         <div id="fb_mod_address" class="x-hidden">
  85   <div class="fieldwrapper wide">
  86     <h3 class="pi_containerSubline">Your address</h3>
  87   </div>
  88   <div class="subtpl">
  89     <div class="cl">
  90       <div class="fieldwrapper">
  91         <label for="street_name" class="street_name">Street name</label>
  92         <div id="street_name"></div>
  93       </div>
  94     </div>
  95
  96     <div class="cl">
  97       <div class="fieldwrapper">
  98         <label for="street_no" class="street_no">Number</label>
  99         <div id="street_no"></div>
 100       </div>
 101     </div>
 102   </div>
 103
 104   <div class="subtpl clear">
 105     <div class="cl">
 106       <div class="fieldwrapper">
 107         <label for="zip" class="zip">ZIP</label>
 108         <div id="zip"></div>
 109       </div>
 110     </div>
 111
 112     <div class="cl">
 113       <div class="fieldwrapper">
 114         <label for="city" class="city">City</label>
 115         <div id="city"></div>
 116       </div>
 117     </div>
 118   </div>
 119
 120   <div class="subtpl">
 121     <div class="fieldwrapper">
 122       <label for="address_details" class="addressDetails">Additional address line <span class="optional"><span>&nbsp;</span>optional</span></label>
 123       <div id="address_details"></div>
 124     </div>
 125   </div>
 126
 127   <div class="subtpl">
 128     <div class="cl">
 129       <div class="fieldwrapper">
 130         <label for="country" class="country">Country</label>
 131         <div id="country"></div>
 132       </div>
 133     </div>
 134   <div class="cl">
 135       <div class="fieldwrapper x-hidden">
 136         <label for="regions" class="regions">State / Region</label>
 137         <div id="regions"> </div>
 138       </div>
 139     </div>
 140   </div>
 141 </div>
 142         <div id="fb_mod_phone" class="x-hidden">
 143   <div class="subtpl clear">
 144     <label for="phone" class="phone">Telephone</label>
 145     <div class="cl">
 146       <div class="fieldwrapper wide">
 147         <div id="phone_country"></div>
 148       </div>
 149     </div>
 150     <div class="cl">
 151       <div class="fieldwrapper wide">
 152         <div id="phone_area"></div>
 153       </div>
 154     </div>
 155     <div class="cl">
 156       <div class="fieldwrapper wide">
 157         <div id="phone_number"></div>
 158       </div>
 159     </div>
 160   </div>
 161 </div>
 162
 163 <div id="fb_mod_customer2" class="x-hidden fb_borderSeperator">
 164   <div class="fieldwrapper wide">
 165     <h3 class="pi_containerSubline">Personal data of customer <a href="#" id="passenger2" class="fb_removePassenger"><span>Remove</span></a></h3>
 166   </div>
 167
 168   <div class="subtpl">
 169     <div class="fieldwrapper">
 170       <div id="adressChkBox2">
 171         <label for="adressCheckbox2" class="customerChk">Copy address above</label>
 172       </div>
 173     </div>
 174   </div>
 175
 176   <div class="subtpl clear">
 177     <div class="fieldwrapper">
 178       <label for="title2" class="title">Title</label>
 179       <div id="title2"></div>
 180     </div>
 181   </div>
 182
 183   <div class="subtpl clear">
 184     <div class="cl">
 185       <div class="fieldwrapper">
 186         <label for="firstname2" class="firstname">First name</label>
 187         <div id="firstname2"></div>
 188       </div>
 189     </div>
 190
 191     <div class="cl">
 192       <div class="fieldwrapper">
 193         <label for="lastname2" class="lastname">Last name</label>
 194         <div id="lastname2"></div>
 195       </div>
 196     </div>
 197   </div>
 198
 199
 200   <div class="subtpl clear">
 201     <div class="cl">
 202       <div class="fieldwrapper">
 203         <label for="email2" class="email">Email</label>
 204         <div id="email2"></div>
 205       </div>
 206     </div>
 207     <div class="cl">
 208       <div class="fieldwrapper">
 209         <label for="r_email2" class="email">Re-enter email</label>
 210         <div id="r_email2"></div>
 211       </div>
 212     </div>
 213   </div>
 214
 215   <div class="subtpl clear">
 216     <div class="cl">
 217       <div class="fieldwrapper">
 218         <label for="mam_number2" class="mam_number">Miles &amp; More number</label>
 219         <div id="mam_number2"></div>
 220       </div>
 221     </div>
 222   </div>
 223
 224   <div class="subtpl">
 225     <div class="cl">
 226       <div class="fieldwrapper">
 227         <label for="street_name2" class="street_name">Street name</label>
 228         <div id="street_name2"></div>
 229       </div>
 230     </div>
 231
 232     <div class="cl">
 233       <div class="fieldwrapper">
 234         <label for="street_no2" class="street_no">Number</label>
 235         <div id="street_no2"></div>
 236       </div>
 237     </div>
 238   </div>
 239
 240   <div class="subtpl clear">
 241     <div class="cl">
 242       <div class="fieldwrapper">
 243         <label for="zip2" class="zip">ZIP</label>
 244         <div id="zip2"></div>
 245       </div>
 246     </div>
 247     <div class="cl">
 248       <div class="fieldwrapper">
 249         <label for="city2" class="city">City</label>
 250         <div id="city2"></div>
 251       </div>
 252     </div>
 253   </div>
 254
 255   <div class="subtpl">
 256     <div class="fieldwrapper">
 257       <label for="address_details2" class="addressDetails">Additional address line</label>
 258       <div id="address_details2"></div>
 259     </div>
 260   </div>
 261
 262   <div class="subtpl">
 263     <div class="cl">
 264       <div class="fieldwrapper">
 265         <label for="country2" class="country">Country</label>
 266         <div id="country2"></div>
 267       </div>
 268     </div>
 269   <div class="cl">
 270       <div class="fieldwrapper x-hidden">
 271         <label for="regions2">State / Region</label>
 272         <div id="regions2"> </div>
 273       </div>
 274     </div>
 275   </div>
 276
 277   <div class="subtpl clear">
 278     <label for="phone2" class="phone">Telephone</label>
 279     <div class="cl">
 280       <div class="fieldwrapper">
 281         <div id="phone_country2" class="cl"></div>
 282       </div>
 283     </div>
 284     <div class="cl">
 285       <div class="fieldwrapper">
 286         <div id="phone_area2"></div>
 287       </div>
 288     </div>
 289     <div class="cl">
 290       <div class="fieldwrapper">
 291         <div id="phone_number2" class="cl"></div>
 292       </div>
 293     </div>
 294   </div>
 295 </div>
 296
 297 <div id="fb_mod_customer3" class="x-hidden fb_borderSeperator">
 298   <div class="fieldwrapper wide">
 299     <h3 class="pi_containerSubline">Personal data of customer <a href="#" id="passenger3" class="fb_removePassenger"><span>Remove</span></a></h3>
 300   </div>
 301
 302   <div class="subtpl">
 303     <div class="fieldwrapper">
 304       <div id="adressChkBox3">
 305         <label for="adressCheckbox3" class="customerChk">Copy address above</label>
 306       </div>
 307     </div>
 308   </div>
 309
 310   <div class="subtpl clear">
 311     <div class="fieldwrapper">
 312       <label for="title3" class="title">Title</label>
 313       <div id="title3"></div>
 314     </div>
 315   </div>
 316
 317   <div class="subtpl clear">
 318     <div class="cl">
 319       <div class="fieldwrapper">
 320         <label for="firstname3" class="firstname">First name</label>
 321         <div id="firstname3"></div>
 322       </div>
 323     </div>
 324
 325     <div class="cl">
 326       <div class="fieldwrapper">
 327         <label for="lastname3" class="lastname">Last name</label>
 328         <div id="lastname3"></div>
 329       </div>
 330     </div>
 331   </div>
 332
 333
 334   <div class="subtpl clear">
 335     <div class="cl">
 336       <div class="fieldwrapper">
 337         <label for="email3" class="email">Email</label>
 338         <div id="email3"></div>
 339       </div>
 340     </div>
 341     <div class="cl">
 342       <div class="fieldwrapper">
 343         <label for="r_email3" class="email">Re-enter email</label>
 344         <div id="r_email3"></div>
 345       </div>
 346     </div>
 347   </div>
 348
 349   <div class="subtpl clear">
 350     <div class="cl">
 351       <div class="fieldwrapper">
 352         <label for="mam_number3" class="mam_number">Miles &amp; More number</label>
 353         <div id="mam_number3"></div>
 354       </div>
 355     </div>
 356   </div>
 357
 358   <div class="subtpl">
 359     <div class="cl">
 360       <div class="fieldwrapper">
 361         <label for="street_name3" class="street_name">Street name</label>
 362         <div id="street_name3"></div>
 363       </div>
 364     </div>
 365
 366     <div class="cl">
 367       <div class="fieldwrapper">
 368         <label for="street_no3" class="street_no">Number</label>
 369         <div id="street_no3"></div>
 370       </div>
 371     </div>
 372   </div>
 373
 374   <div class="subtpl clear">
 375     <div class="cl">
 376       <div class="fieldwrapper">
 377         <label for="zip3" class="zip">ZIP</label>
 378         <div id="zip3"></div>
 379       </div>
 380     </div>
 381     <div class="cl">
 382       <div class="fieldwrapper">
 383         <label for="city3" class="city">City</label>
 384         <div id="city3"></div>
 385       </div>
 386     </div>
 387   </div>
 388
 389   <div class="subtpl">
 390     <div class="fieldwrapper">
 391       <label for="address_details3" class="addressDetails">Additional address line</label>
 392       <div id="address_details3"></div>
 393     </div>
 394   </div>
 395
 396   <div class="subtpl">
 397     <div class="cl">
 398       <div class="fieldwrapper">
 399         <label for="country3" class="country">Country</label>
 400         <div id="country3"></div>
 401       </div>
 402     </div>
 403   <div class="cl">
 404       <div class="fieldwrapper x-hidden">
 405         <label for="regions3">State / Region</label>
 406         <div id="regions3"> </div>
 407       </div>
 408     </div>
 409   </div>
 410
 411   <div class="subtpl clear">
 412     <label for="phone3" class="phone">Telephone</label>
 413     <div class="cl">
 414       <div class="fieldwrapper">
 415         <div id="phone_country3" class="cl"></div>
 416       </div>
 417     </div>
 418     <div class="cl">
 419       <div class="fieldwrapper">
 420         <div id="phone_area3"></div>
 421       </div>
 422     </div>
 423     <div class="cl">
 424       <div class="fieldwrapper">
 425         <div id="phone_number3" class="cl"></div>
 426       </div>
 427     </div>
 428   </div>
 429 </div>
 430
 431         <div id="addCustomer"></div>
 432       </div>
 433
 434
 435       <div id="fb_mod_prm">
 436   <div id="fb_mod_flightDetails" class="lh_fbMargin fb_borderSeperator x-hidden">
 437   <div class="fieldwrapper wide">
 438     <h3 class="pi_containerSubline">Flight information</h3>
 439   </div>
 440
 441   <div class="subtpl">
 442     <div class="cl">
 443       <div class="fieldwrapper">
 444         <label for="fd_file_key">File key</label>
 445         <div id="fd_FileKey"></div>
 446       </div>
 447     </div>
 448
 449     <div class="cl">
 450       <div class="fieldwrapper">
 451         <label for="fd_flight_number" class="flight_number">Flight number</label> <span class="flight_number_prefix">LH</span>
 452         <div id="fd_FlightNumber"></div>
 453       </div>
 454     </div>
 455   </div>
 456
 457   <div class="subtpl clear">
 458     <div class="cl">
 459       <div class="fieldwrapper wide">
 460         <label for="fd_flight_date">Flight date</label>
 461         <div id="fd_flight_date">
 462           <input type="text" id="FlightDate2" name="FlightDate2" class="fb_protect datepicker" widgetid="FlightDate2" readonly="">
 463           <input type="hidden" id="FlightDateHidden2" name="FlightDateHidden2" disabled="">
 464         </div>
 465       </div>
 466     </div>
 467     <div class="cl">
 468       <div class="fieldwrapper wide">
 469         <label for="fd_flight_time">Flight time</label>
 470         <div id="fd_FlightTime"></div>
 471       </div>
 472     </div>
 473   </div>
 474 </div>
 475   <div id="fb_mod_assistanceType" class="lh_fbMargin fb_borderSeperator x-hidden">
 476   <div class="fieldwrapper wide">
 477     <h3 class="pi_containerSubline">Please choose the appropriate option</h3>
 478   </div>
 479
 480   <div class="subtpl">
 481     <div class="cl">
 482       <div class="fieldwrapper">
 483         <div id="at_LongDistances"></div>
 484         <label for="at_long_distances_radio" class="fb_radio">I cannot walk long distances, however, short distances and stairs are no problem</label>
 485       </div>
 486     </div>
 487   </div>
 488   <div class="subtpl">
 489     <div class="cl">
 490       <div class="fieldwrapper">
 491         <div id="at_Staircases"></div>
 492         <label for="at_staircases_radio" class="fb_radio">I can walk short and long distances, but I have difficulties with stairs</label>
 493       </div>
 494     </div>
 495   </div>
 496   <div class="subtpl">
 497     <div class="cl">
 498       <div class="fieldwrapper wide">
 499         <div id="at_Walking"></div>
 500         <label for="at_walking_radio" class="fb_radio">I cannot walk at all</label>
 501       </div>
 502     </div>
 503   </div>
 504 </div>
 505   <div id="fb_mod_disabilityType" class="lh_fbMargin fb_borderSeperator x-hidden">
 506   <div class="subtpl">
 507     <div class="cl">
 508       <div class="fieldwrapper">
 509         <div id="dt_Blind"></div>
 510         <label for="dt_blind_chkbox" class="fb_radio">I am blind or have a severe visual impairment.</label>
 511       </div>
 512     </div>
 513   </div>
 514   <div class="subtpl">
 515     <div class="cl">
 516       <div class="fieldwrapper">
 517         <div id="dt_Deaf"></div>
 518         <label for="dt_deaf_chkbox" class="fb_radio">I am deaf or have a severe hearing impairment</label>
 519       </div>
 520     </div>
 521   </div>
 522   <div class="subtpl">
 523     <div class="cl">
 524       <div class="fieldwrapper wide">
 525         <div id="dt_Dpna"></div>
 526         <label for="dt_dpna_chkbox" class="fb_radio">I need help finding my way around</label>
 527       </div>
 528     </div>
 529   </div>
 530 </div>
 531   <div id="fb_mod_companionReasons" class="lh_fbMargin fb_borderSeperator x-hidden">
 532   <div class="subtpl">
 533     <div class="cl">
 534       <div class="fieldwrapper">
 535         <div id="cr_Hc"></div>
 536         <label for="cr_hc_radio" class="fb_radio">I have to travel with an especially trained dog due to my handicap</label>
 537       </div>
 538     </div>
 539   </div>
 540   <div class="subtpl">
 541     <div class="cl">
 542       <div class="fieldwrapper wide">
 543         <div id="cr_Pr"></div>
 544         <label for="cr_pr_radio" class="fb_radio">I need to travel in companionship of a dog due to psychological reasons</label>
 545       </div>
 546     </div>
 547   </div>
 548 </div>
 549   <div class="subtpl">
 550     <div class="cr">
 551       <div id="fd_reset" class="x-hidden"></div>
 552     </div>
 553   </div>
 554
 555 </div>
 556       <div id="fb_mod_pir" class="lh_fbMargin fb_borderSeperator x-hidden">
 557   <div class="fieldwrapper wide">
 558     <h3 class="pi_containerSubline">Property Irregularity Report Number (PIR)</h3>
 559   </div>
 560
 561   <div class="subtpl">
 562     <div class="cl">
 563       <div class="fieldwrapper wide">
 564         <label for="pir">PIR number / File Reference (e.g. FRALH12345)</label>
 565         <div id="pir"></div>
 566       </div>
 567     </div>
 568   </div>
 569 </div>
 570       <div id="fb_mod_flight" class="lh_fbMargin fb_borderSeperator  x-hidden">
 571   <div class="fieldwrapper wide">
 572     <h3 class="pi_containerSubline">Flight information<span class="optional"><span>&nbsp;</span>optional</span></h3>
 573   </div>
 574   <div class="subtpl">
 575     <div class="fieldwrapper">
 576       <label for="FlightDate" class="flightDate">Flight date</label>
 577       <input type="text" id="FlightDate" name="FlightDate" class="fb_protect datepicker" widgetid="FlightDate" readonly="">
 578       <input type="hidden" id="FlightDateHidden" name="FlightDateHidden" disabled="">
 579     </div>
 580   </div>
 581
 582   <div class="subtpl clear">
 583     <div class="cl">
 584       <div class="fieldwrapper">
 585         <label for="airline" class="airline">Airline</label>
 586         <div id="airline"></div>
 587       </div>
 588     </div>
 589
 590     <div class="cl">
 591       <div class="fieldwrapper">
 592         <label for="flight_number" class="flight_number">Flight number</label> <span class="flight_number_prefix"></span>
 593         <div id="flight_number"></div>
 594       </div>
 595     </div>
 596   </div>
 597
 598   <div class="subtpl">
 599     <div class="fieldwrapper">
 600       <label for="seat_number" class="seat_number">Seat number</label>
 601       <div id="seat_number"></div>
 602     </div>
 603   </div>
 604
 605   <div class="subtpl clear">
 606     <div class="fieldwrapper wide aa-link">
 607       <label for="f-originName0" class="origin">Origin</label>
 608       <input type="text" autocomplete="off" id="f-originName0" name="originName">
 609       <input type="hidden" id="f-originCode0" name="originCode">
 610       <a href="#" id="lnk-origin" data-dojo-type="lh.widget.AirportAtlas" data-dojo-props="fieldId:'f-originName0',hiddenFieldId:'f-originCode0',url:'/dlvutils/AirportAtlasApplication?app=FB&amp;selected=DE&amp;lang=en',serviceUrl:'/dlvutils/AirportAtlasApplication', app:'FB', language:'en'">
 611         <span class="airport-dir">&nbsp;</span>
 612       </a>
 613       <div id="lh-typeahead-append-node-f-origin0" class="dijitMenu" tabindex="-1" style="display:none;">
 614       <div id="lh-typeahead-close-f-origin0" class="dijitMenuCloseButton">close</div></div>
 615       <div id="lh-airport-f-origin0" style="display:none;"></div>
 616     </div>
 617   </div>
 618
 619   <div class="subtpl clear">
 620     <div class="fieldwrapper wide aa-link">
 621       <label for="f-destinationName0">Destination</label>
 622       <input type="text" autocomplete="off" id="f-destinationName0" name="destinationName">
 623       <input type="hidden" id="f-destinationCode0" name="destinationCode">
 624       <a href="#" id="lnk-destination" data-dojo-type="lh.widget.AirportAtlas" data-dojo-props="fieldId:'f-destinationName0',hiddenFieldId:'f-destinationCode0',url:'/dlvutils/AirportAtlasApplication?app=FB&amp;lang=en',serviceUrl:'/dlvutils/AirportAtlasApplication', app:'FB', language:'en'">
 625         <span class="airport-dir">&nbsp;</span>
 626       </a>
 627       <div id="lh-typeahead-append-node-f-destination0" class="dijitMenu" tabindex="-1" style="display:none;">
 628       <div id="lh-typeahead-close-f-destination0" class="dijitMenuCloseButton">close</div></div>
 629       <div id="lh-airport-f-destination" style="display:none;"></div>
 630     </div>
 631   </div>
 632 </div>
 633       <div id="fb_mod_ticket" class="lh_fbMargin fb_borderSeperator x-hidden">
 634   <div class="fieldwrapper wide">
 635     <h3 class="pi_containerSubline">Ticket / booking information<a class="infoMessage" title="Information" id="ticket_toolTip1" href="javascript:void(0);">&nbsp;</a></h3>
 636   </div>
 637   <div connectid="ticket_toolTip1" dojotype="dijit.Tooltip" showdelay="250" label="Please enter your ticketnumber (s. ticket) or the booking code / filekey from your booking confirmation" class="dijitTooltipData" id="dijit_Tooltip_3" lang="en" widgetid="dijit_Tooltip_3">&nbsp;</div>
 638
 639   <div class="fbRadioWrapper">
 640     <div class="fieldwrapper wide">
 641       <label for="ticket_no" class="marginLeft">Ticket number</label>
 642       <div id="ticket_no"></div>
 643     </div>
 644   </div>
 645
 646   <div class="fbRadioWrapper">
 647     <div class="fieldwrapper wide">
 648       <label for="file_key" class="marginLeft">File key</label>
 649       <div id="file_key"></div>
 650     </div>
 651   </div>
 652 </div>
 653       <div id="fb_mod_refund" class="lh_fbMargin fb_borderSeperator x-hidden">
 654   <div class="fieldwrapper wide">
 655     <h3 class="pi_containerSubline">Refund <a class="infoMessage" title="Information" id="ticket_toolTip1" href="javascript:void(0);">&nbsp;</a></h3>
 656     <div connectid="ticket_toolTip1" dojotype="dijit.Tooltip" showdelay="250" label="Please enter your details" class="dijitTooltipData" id="dijit_Tooltip_4" lang="en" widgetid="dijit_Tooltip_4">&nbsp;</div>
 657   </div>
 658
 659   <div class="subtpl">
 660     <div class="cl">
 661       <div class="fieldwrapper">
 662         <div id="refundTicketChkbox">
 663           <label for="refundTicketCheckbox" class="customerChk">Refund entire ticket</label>
 664         </div>
 665       </div>
 666     </div>
 667   </div>
 668
 669   <div class="subtpl">
 670     <div class="cl">
 671       <div class="fieldwrapper">
 672         <label for="refund_reason">Refund reason</label>
 673         <div id="refund_reason"></div>
 674       </div>
 675     </div>
 676   </div>
 677
 678   <div class="subtpl">
 679     <div class="cl">
 680       <div class="fieldwrapper wide">
 681         <label for="refund_filey_key" class="refund_file_key">File key <span class="optional"><span>&nbsp;</span>optional</span></label>
 682         <div id="refund_file_key"></div>
 683       </div>
 684     </div>
 685
 686     <div class="cl">
 687       <div class="fieldwrapper wide">
 688         <label for="ticket_no_lh" class="ticket_no_lh">Ticket number</label>
 689         <span class="ticket_number_prefix">220</span><div id="ticket_no_lh"></div>
 690       </div>
 691     </div>
 692   </div>
 693
 694   <div class="subtpl x-hidden">
 695     <div class="cl">
 696       <div class="fieldwrapper wide">
 697         <label for="refund_segment">Travel segments to be refunded</label>
 698         <div id="refund_segment"></div>
 699       </div>
 700     </div>
 701   </div>
 702 </div>
 703       <div id="fb_mod_bank" class="lh_fbMargin fb_borderSeperator x-hidden">
 704   <div class="fieldwrapper wide">
 705     <h3 class="pi_containerSubline">Bank account information<a class="infoMessage" id="bank_toolTip1" href="javascript:void(0);">&nbsp;</a></h3>
 706     <div connectid="bank_toolTip1" dojotype="dijit.Tooltip" showdelay="250" label="Please enter your bank account information" class="dijitTooltipData" id="dijit_Tooltip_5" lang="en" widgetid="dijit_Tooltip_5">&nbsp;</div>
 707   </div>
 708
 709   <div class="subtpl">
 710     <div class="cl">
 711       <div class="fieldwrapper">
 712         <label for="card_holder">Account holder</label>
 713         <div id="card_holder"></div>
 714       </div>
 715     </div>
 716     <div class="cl">
 717       <div class="fieldwrapper">
 718         <label for="bank_name">Bank name</label>
 719         <div id="bank_name"></div>
 720       </div>
 721     </div>
 722   </div>
 723
 724   <div class="subtpl">
 725     <div class="cl">
 726       <div class="fieldwrapper wide">
 727         <label for="iban">IBAN Number</label>
 728         <div id="iban"></div>
 729       </div>
 730     </div>
 731
 732     <div class="cl">
 733       <div class="fieldwrapper wide">
 734         <label for="bic">SWIFT/BIC code</label>
 735         <div id="bic"></div>
 736       </div>
 737     </div>
 738   </div>
 739 </div>
 740       <div id="fb_mod_technial" class="lh_fbMargin fb_borderSeperator x-hidden">
 741   <div class="fieldwrapper wide">
 742     <h3 class="pi_containerSubline">Technical information</h3>
 743   </div>
 744
 745   <div class="subtpl">
 746     <div class="cl">
 747       <div class="fieldwrapper wide">
 748         <label for="browser">Browser name</label>
 749         <div id="browser"></div>
 750       </div>
 751     </div>
 752
 753     <div class="cl">
 754       <div class="fieldwrapper wide">
 755         <label for="os">Operating system</label>
 756         <div id="os"></div>
 757       </div>
 758     </div>
 759   </div>
 760 </div>
 761       <div id="fb_mod_feedbackID" class="lh_fbMargin fb_borderSeperator x-hidden">
 762   <div class="fieldwrapper wide">
 763     <h3 class="pi_containerSubline">Feedback ID</h3>
 764   </div>
 765
 766   <div class="subtpl">
 767     <div class="fieldwrapper wide">
 768       <label for="feedbackId">Please enter your feedback ID</label>
 769       <div id="feedbackId"></div>
 770     </div>
 771   </div>
 772 </div>
 773       <div id="fb_mod_comment" class="lh_fbMargin fb_borderSeperator x-hidden">
 774   <div class="fieldwrapper wide">
 775     <h3 class="pi_containerSubline">Your feedback or question</h3>
 776   </div>
 777   <div class="fieldwrapper wide">
 778     <div id="comment"></div>
 779   </div>
 780 </div>
 781
 782
 783     </div>
 784
 785
 786       <input type="hidden" class="x-fup-hd-filename" name="FileName_1" id="attach_filename_1" value="">
 787       <input type="hidden" class="x-fup-hd-filename" name="FileName_2" id="attach_filename_2" value="">
 788       <input type="hidden" class="x-fup-hd-filename" name="FileName_3" id="attach_filename_3" value="">
 789       <input type="hidden" class="x-fup-hd-filename" name="FileName_4" id="attach_filename_4" value="">
 790       <input type="hidden" class="x-fup-hd-filename" name="FileName_5" id="attach_filename_5" value="">
 791       <input type="hidden" class="x-fup-hd-filename" name="FileName_6" id="attach_filename_6" value=""> <br>
 792
 793       <input type="hidden" class="x-fup-hd-fileid" name="FileId_1" id="attach_fileid_1" value="">
 794       <input type="hidden" class="x-fup-hd-fileid" name="FileId_2" id="attach_fileid_2" value="">
 795       <input type="hidden" class="x-fup-hd-fileid" name="FileId_3" id="attach_fileid_3" value="">
 796       <input type="hidden" class="x-fup-hd-fileid" name="FileId_4" id="attach_fileid_4" value="">
 797       <input type="hidden" class="x-fup-hd-fileid" name="FileId_5" id="attach_fileid_5" value="">
 798       <input type="hidden" class="x-fup-hd-fileid" name="FileId_6" id="attach_fileid_6" value="">
 799
 800
 801     </form>