This illustration shows a completed web form.

In the top left is a print icon. 

Below that is the Name free-form text field. 

Below that is the Phone, Email, and Travel Amount free-form text fields, listed left to right. 

Below them are the Trip Details and Expenses (selected) tabs. 

On the Expenses tab, there are three Expense sections. Each section has a Expense Type drop-down list and an Amount free-form text field.

All fields in the web form have values.