<commit_before><div id="requirement_utility_services">
  <h1>Utility Services</h1>
  <p>[@todo]</p>
  
  <form>
  </form>
</div><!-- /#requirement_utility_services -->
<commit_msg>Add utility services panel<commit_after><div id="requirement_utility_services">
  <h1>Utility Services</h1>
  <p>You've told us you're working out of a commercial location, which means you'll need utility service.</p>
  <h3>Water, Sewage, and Trash Service</h3>
  <p>These are all provided by the City of Santa Cruz, and we'll help you get your application in with this guide to save you a trip to City Hall.</p>
  <p>For trash service, you must place the container on private property unless street access is permitted by the Public Works Department.</p>
  <h3>Gas and Power</h3>
  <p>In our City, gas and power is supplied by PG&E. You'll have to contact them on your own if your landlord or building owner hasn't set up a separate account and meter for you.</p>

  <form>
    <label>
      Business Name
      <input type="text" name="business_name">
    </label>
    <label>
      Service Address (street, city, zip)
      <input type="text" name="business_physical_address_street">
      <input type="text" name="business_physical_address_city">
      <input type="text" name="business_phyiscal_address_zip">
    </label>
    <label>
      Previous Service Address in Santa Cruz within the last 24 months (optional):
      <input type="text" name="business_prev_service_adddress_street">
      <input type="text" name="business_prev_service_address_city">
      <input type="text" name="business_prev_service_address_zip">
    </label>
    <label>
      Business Phone
      <input type="text" name="business_phone">
    </label>
    <label>
      Business Fax
      <input type="text" name="business_fax">
    </label>
    <label>
      Business Email
      <input type="text" name="business_email">
    </label>
    <label>
      Date to begin service
      <input type="date">
    </label>
    <label>
      Customer Name (last, first, middle initial)
      <input type="text" name="owner_name">
    </label>
    <label>
      Customer Home Address (street, city, state, zip)
      <input type="text" name="owner_physical_address_street">
      <input type="text" name="owner_physical_address_city">
      <input type="text" name="owner_physical_address_state">
      <input type="text" name="owner_physical_address_zip">
    </label>
    <label>
      Customer Billing Address (street, city, state, zip)
      <input type="text" name="owner_billing_address_street">
      <input type="text" name="owner_billing_address_city">
      <input type="text" name="owner_billing_address_state">
      <input type="text" name="owner_billing_address_zip">
    </label>
    <label>
      Home Phone
      <input type="text" name="owner_home_phone">
    </label>
    <label>
      Daytime Phone
      <input type="text" name="owner_daytime_phone">
    </label>
    <label>
      Tax ID or Driver's License:
      <input type="text" name="tax_id">
    </label>
    <label>
      Garbage Service:
        I would like <input type="text" name="trash_can_20_gal_qty"> 20 gallon garbage cans ($16.16/mo),
        <input type="text" name="trash_can_32_gal_qty"> 32 gallon garbage cans ($26.05/mo), and 
        <input type="text" name="trash_can_68_gal_qty"> 68 gallon garbage can ($55.84/mo).
    </label>
    <label>
      Containers:
        <input type="text" name="trash_container_1_cubic_yard_qty"> 1-cubic yard container ($160.42 per container per pickup) <input type="text" name="trash_container_1_cubic_yard_pickups">
        <input type="text" name="trash_container_2_cubic_yard_qty"> 2-cubic yard container ($239.11 per container per pickup) <input type="text" name="trash_container_2_cubic_yard_pickups">
        <input type="text" name="trash_container_4_cubic_yard_qty"> 4-cubic yard container ($408.94 per container per pickup) <input type="text" name="trash_container_4_cubic_yard_pickups">
        <input type="text" name="trash_container_6_cubic_yard_qty"> 6-cubic yard container ($578.77 per container per pickup) <input type="text" name="trash_container_6_cubic_yard_pickups">
        Where will you be placing the container? Street placement is not allowed unless approved in advance by the Public Works Department.
    </label>
  </form>
</div><!-- /#requirement_utility_services -->

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