                            <div class="col-xl-9 col-lg-8">
                                <div id="wizard_container">
                                    <div id="top-wizard">
                                        <strong>Progress</strong>
                                        <div id="progressbar"></div>
                                    </div><!-- /top-wizard -->

                                    <form name="example-1" id="wrapped" method="POST" action="/submit/">
                                        <input id="website" name="website" type="text" value=""><!-- Leave for security protection, read docs for details -->
                                        <div id="middle-wizard">
                                            <div class="step">
                                                <h3 class="main_question"><strong>1/3</strong>Let's start with your address</h3>
                                                
                                                    <div class="row">
                                                        <div class="col-lg-10">
                                                            <div class="form-group select">
                                                                <label>Your community:</label>

                                                                <div class="styled-select">
                                                                    <select name="community" class="required" name="select_1">
                                                                        <option value="" selected>Select</option>
                                                                        <option>Argentine Township</option> 
                                                                        <option>Atlas Township</option> 
                                                                        <option>Charter Township of Genesee</option> 
                                                                        <option>Charter Township of Grand Blanc</option> 
                                                                        <option>City of Burton</option> 
                                                                        <option>City of Clio</option> 
                                                                        <option>Davison Township</option> 
                                                                        <option>Flint Township</option> 
                                                                        <option>Flushing Township</option> 
                                                                        <option>Mt. Morris Township</option> 
                                                                        <option>Richfield Township</option> 
                                                                        <option>Thetford Township Office</option>
                                                                    </select>
                                                                </div>
                                                            </div>
                                                        </div>
                                                        <div class="col-lg-10">
                                                            <div class="form-group select">
                                                                <label>Your street:</label>

                                                                <div class="styled-select">
                                                                    <select name="street" class="required" name="select_1">
                                                                        <option value="" selected>Select</option>
                                                                        <option value="elm-street">Elm Street</option>
                                                                        <option value="maple-avenue">Maple Avenue</option>
                                                                        <option value="oak-lane">Oak Lane</option>
                                                                        <option value="cedar-road">Cedar Road</option>
                                                                        <option value="pine-drive">Pine Drive</option>
                                                                        <option value="main-street">Main Street</option>
                                                                        <option value="birch-court">Birch Court</option>
                                                                        <option value="willow-way">Willow Way</option>
                                                                        <option value="hickory-street">Hickory Street</option>
                                                                        <option value="sycamore-avenue">Sycamore Avenue</option>
                                                                        <option value="juniper-lane">Juniper Lane</option>
                                                                        <option value="chestnut-road">Chestnut Road</option>
                                                                        <option value="poplar-drive">Poplar Drive</option>
                                                                        <option value="rose-street">Rose Street</option>
                                                                        <option value="tulip-court">Tulip Court</option>
                                                                        <option value="iris-way">Iris Way</option>
                                                                        <option value="magnolia-street">Magnolia Street</option>
                                                                        <option value="daisy-avenue">Daisy Avenue</option>
                                                                        <option value="lilac-lane">Lilac Lane</option>
                                                                        <option value="sunflower-road">Sunflower Road</option>
                                                                    </select>
                                                                </div>
                                                            </div>
                                                        </div>
                                                        <div class="col-lg-10">
                                                            <div class="form-group select">
                                                                <label>Your house number:</label>
                                                                <input type="text" name="house_number" class="form-control required" placeholder="12345">
                                                            </div>
                                                        </div>
                                                    </div>



                                               
                                                
                                                
                                            </div><!-- /step 1-->
                                            

                                            <div class="step">
                                                <h3 class="main_question"><strong>2/3</strong>What type of pickup can we help you with?</h3>
                                                
                                                <div class="form-group radio_questions">
                                                    <label>1. Waste Pickup
                                                        <input name="type" type="radio" value="Waste Pickup" class="icheck required">
                                                    </label>
                                                </div>
                                                <div class="form-group radio_questions">
                                                    <label>2. Recycling Pickup
                                                        <input name="type" type="radio" value="Recycling Pickup" class="icheck required">
                                                    </label>
                                                </div>
                                                <div class="form-group radio_questions">
                                                    <label>3. Compost Pickup
                                                        <input name="type" type="radio" value="Compost Pickup" class="icheck required">
                                                    </label>
                                                </div>
                                            </div><!-- /step 2-->

                                            <div class="submit step">
                                                <h3 class="main_question"><strong>3/3</strong>Please specify what we can help you with</h3>

                                                <div class="row add_bottom_30">
                                                   
                                                    <div class="col-sm-6">
                                                        <div class="form-group checkbox_questions">
                                                            <label>
                                                                <input name="type_checkbox" type="checkbox" value="Missed pickup" class="icheck required">Missed pickup
                                                            </label>
                                                        </div>
                                                        <div class="form-group checkbox_questions">
                                                            <label>
                                                                <input name="type_checkbox" type="checkbox" value="Left a mess" class="icheck required">Left a mess
                                                            </label>
                                                        </div>
                                                        <div class="form-group checkbox_questions">
                                                            <label>
                                                                <input name="type_checkbox" type="checkbox" value="Personal conflict" class="icheck required">Personal conflict
                                                            </label>
                                                        </div>
                                                    </div>
                                                    
                                                    <div class="col-sm-6">
                                                        <div class="form-group checkbox_questions">
                                                            <label>
                                                                <input name="type_checkbox" type="checkbox" value="Damage to property" class="icheck required">Damage to property
                                                            </label>
                                                        </div>
                                                        <div class="form-group checkbox_questions">
                                                            <label>
                                                                <input name="type_checkbox" type="checkbox" value="Damage to Emterra's Property" class="icheck required">Damage to Emterra's Property
                                                            </label>
                                                        </div>
                                                        <div class="form-group checkbox_questions">
                                                            <label>
                                                                <input name="type_checkbox" type="checkbox" value="Other" class="icheck required">Other
                                                            </label>
                                                        </div>
                                                        
                                                    </div>
                                                </div><!-- /row-->
                                                <div class="form-group textarea_info">
                                                    <label>Please provide a detailed description</label>
                                                    <textarea name="details" class="form-control" style="height:150px;" placeholder="Please describe your issue in detail"></textarea>
                                                </div>
                                            </div><!-- /step 3-->

                                            

                                        </div><!-- /middle-wizard -->
                                        <div id="bottom-wizard">
                                            <button type="button" name="backward" class="backward">Backward </button>
                                            <button type="button" name="forward" class="forward">Forward</button>
                                            <button type="submit" name="process" class="submit">Submit</button>
                                        </div><!-- /bottom-wizard -->
                                    </form>
                                </div><!-- /Wizard container -->

                            </div><!-- /col -->
