<p>I/We,</p>

<label> Tenant/s Name/s: *
[text* t-name size:100 class:form-control] 
<span>Hereby give notice of our intention to vacate the premises known as</span>
</label>
<label> Property Address *
[text* p-address size:100 class:form-control] 
</label>
<label> On the Vacating Date: * (Please ensure that you allow the correct notice period.)
[text* v-date size:100 class:form-control] 
</label>

<label> Your Email
    [email* your-email size:100 class:form-control] </label>

<label>Home Phone
    [text* phone size:100 class:form-control] </label>
<label> Work Phone
[text* w-phone size:100 class:form-control] </label>

<label> Mobile Phone
[text* m-phone size:100 class:form-control] </label>

<label> Reason for Notice *
    [text* notice size:100 class:form-control] </label>

<label> Forwarding address *
   [text* forwarding-address size:100 class:form-control] </label>
<label>[checkbox checkbox-607 label_first exclusive "I/We are breaking our Lease"]</label>
[submit "Submit"]