<div class="form-group gcore-form-row" id="form-row-radio3"><label for="radio3" class="control-label gcore-label-left gcore-label-checkbox">Why ?</label>
<div class="gcore-input gcore-display-table" id="fin-radio3"><div class="gcore-single-column" id="fclmn2"><div class="gcore-radio-item" id="fitem10"><input name="radio3" id="radio3" value="work" class="A" title="" style="" data-load-state="" data-tooltip="" type="radio" />
<label class="control-label gcore-label-checkbox" for="radio3">work</label></div>
<div class="gcore-radio-item" id="fitem11"><input name="radio3" id="radio31" value="travel" class="A" title="" style="" data-load-state="" data-tooltip="" type="radio" />
<label class="control-label gcore-label-checkbox" for="radio31">travel</label></div>
<div class="gcore-radio-item" id="fitem12"><input name="radio3" id="radio32" value="other" class="A" title="" style="" data-load-state="" data-tooltip="" type="radio" />
<label class="control-label gcore-label-checkbox" for="radio32">other</label></div></div><span class="help-block">Please select "other"</span></div></div><div class="form-group gcore-form-row" id="form-row-text4"><label for="text4" class="control-label gcore-label-left">Other info</label>
<div class="gcore-input gcore-display-table" id="fin-text4"><input name="text4" id="text4" value="" placeholder="" class="form-control A" title="" style="" data-inputmask="" data-load-state="hidden_parent" data-tooltip="" type="text" /></div></div><div class="form-group gcore-form-row" id="form-row-checkbox1"><label for="checkbox1" class="control-label gcore-label-left gcore-label-checkbox"> </label>
<div class="gcore-input gcore-display-table" id="fin-checkbox1"><div class="gcore-checkbox-item" id="fitem13"><input name="checkbox1" id="checkbox1" value="1" class="A" title="" style="" data-load-state="" data-tooltip="" type="checkbox" />
<label class="control-label gcore-label-checkbox" for="checkbox1">I accept your terms & conditions!</label></div></div></div><div class="form-group gcore-form-row" id="form-row-button2"><div class="gcore-input gcore-display-table" id="fin-button2"><input name="button2" id="button2" type="submit" value="Submit" class="form-control A" style="" data-load-state="disabled" /></div></div>