vapemap/app/stores/templates/stores/claim_form.html

{% extends "base.html" %}
{% load bootstrap %}

{% block content %}
<div class="page-header">
    <h1>Claim Request - {{ target_obj }}</h1>
</div>

<p>This form is to submit a request to claim a store/chain and assign it to your login. If you are a store or chain manager for {{ target_obj }} please fill in the following note with proof of your claim. Once you submit the request it'll be reviewed by {{ site.name }} staff who may need to contact you to confirm your request.</p>

<p>In the note please submit as many of the following details you can.</p>

<ul>
    <li>Full name.</li>
    <li>Contact phone number.</li>
    <li>Email address.</li>
    <li>Links to your store's website or Facebook page with the store's details listed.</li>
</ul>

<form class="form form-horizontal" method="post">
{{ form|bootstrap }}
{% csrf_token %}
<input class="btn" type="submit">
</form>
{% endblock %}