Travel Insurance Sample

This sample form is a part of Theming Drupal Web Forms article. That article explains how to style web forms using tables. It also contains the source of this webform.

Submitting the form will take you to a page that displays "Thank you for your order". Data submitted using this webform will be deleted.

Required fields are marked with *.

Country of residence: *
Gender: *
Extra protection: *	Winter sports Diving Golf equipment
Premium: *

Your details

First name: *
Surname: *
SSN: *
Phone number: *
Email address:
Street address: *
Postal code: *
City: *

Spouse/Partner

	First name	Surname	SSN
Spouse/Partner

Children

	First name	Surname	SSN
Child1
Child2
Child3
Child4
Child5
Child6

Confirmation: *	I have read terms and conditions Please, read terms and conditions.
Marketing: *	I would like to receive information about insurances No, I don't want to be informed

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Travel Insurance Sample