1 <div id="acq-eligible-claim-controls">
2 <label for="acq-eligible-claim-type">[% l('Claim type:') %]</label>
3 <span id="acq-eligible-claim-type"></span>
4 <label for="acq-eligible-claim-note">[% l('Note:') %]</label>
5 <input dojoType="dijit.form.TextBox" id="acq-eligible-claim-note" />
6 <button id="acq-eligible-claim-submit">[% l('Claim') %]</button>