{
  "title": "Payment Request",
  "description": "Claim Form to request a payment for Goods and/or Services provided",
  "pages": [
    {
      "name": "page1",
      "elements": [
        {
          "type": "text",
          "name": "name",
          "title": "Payee Name",
          "description": "Legal name of the Entity for which the payment request is being made",
          "isRequired": true
        },
        {
          "type": "text",
          "name": "identifier",
          "title": "Payee Identifier",
          "description": "A registered and valid Entity DID",
          "isRequired": true,
          "validators": [
            {
              "type": "regex",
              "text": "Check the DID format",
              "regex": "^did:ixo:entity:[0-9a-fA-F]{32}$"
            }
          ],
          "placeholder": "did:ixo:entity:"
        },
        {
          "type": "text",
          "name": "email",
          "title": "Email",
          "description": "Where correspondence relating to the claim may be sent",
          "inputType": "email",
          "placeholder": "Email Address"
        },
        {
          "type": "boolean",
          "name": "invoice",
          "title": "Submit an Invoice",
          "isRequired": true
        },
        {
          "type": "boolean",
          "name": "documentation",
          "title": "Submit Supporting Documentation",
          "isRequired": true
        }
      ],
      "title": "Claimant Details",
      "description": "About the Entity requesting payment"
    },
    {
      "name": "page2",
      "elements": [
        {
          "type": "text",
          "name": "reference",
          "title": "Reference",
          "description": "Such as Invoice number",
          "isRequired": true
        },
        {
          "type": "text",
          "name": "amount",
          "title": "Claimed Amount",
          "description": "Total in the Base Currency",
          "inputType": "number"
        },
        {
          "type": "tagbox",
          "name": "currency",
          "title": "Base Currency",
          "description": "In which the costs have been incurred ",
          "choices": [
            {
              "value": "Item 5",
              "text": "USDC"
            },
            {
              "value": "Item 1",
              "text": "USD"
            },
            {
              "value": "Item 2",
              "text": "CHF"
            },
            {
              "value": "Item 3",
              "text": "EUR"
            },
            {
              "value": "Item 4",
              "text": "IXO"
            },
            {
              "value": "Item 6",
              "text": "ETH"
            },
            {
              "value": "Item 7",
              "text": "BTC"
            }
          ],
          "maxSelectedChoices": 1,
          "minSelectedChoices": 1
        },
        {
          "type": "text",
          "name": "InvoiceDueDate",
          "title": "Payment Due Date",
          "inputType": "date"
        },
        {
          "type": "file",
          "name": "invoice_document",
          "visibleIf": "{invoice} = true",
          "title": "Invoice Upload",
          "isRequired": true,
          "waitForUpload": true,
          "needConfirmRemoveFile": true
        }
      ],
      "title": "Invoice Details",
      "description": "Document"
    },
    {
      "name": "page3",
      "elements": [
        {
          "type": "tagbox",
          "name": "currency_payment",
          "title": "Payment Currency",
          "description": "Cryptocurrencies Only",
          "showCommentArea": true,
          "commentPlaceholder": "Special Instructions",
          "choices": [
            {
              "value": "Item 8",
              "text": "USDC"
            },
            {
              "value": "Item 4",
              "text": "IXO"
            },
            {
              "value": "Item 6",
              "text": "ETH"
            },
            {
              "value": "Item 7",
              "text": "BTC"
            }
          ],
          "showOtherItem": true,
          "maxSelectedChoices": 1,
          "minSelectedChoices": 1,
          "closeOnSelect": true
        },
        {
          "type": "text",
          "name": "accountAddress",
          "title": "Account Address",
          "description": "Ensure this is a valid address for receiving the cryptocurrency payment on the network you select",
          "isRequired": true
        },
        {
          "type": "dropdown",
          "name": "network",
          "visible": false,
          "title": "Blockchain Network",
          "description": "Ensure the Account Address is valid on this network",
          "isRequired": true,
          "showCommentArea": true,
          "commentText": "Instructions (optional)",
          "commentPlaceholder": "Special Instructions",
          "choices": [
            {
              "value": "ethereum",
              "text": "Ethereum"
            },
            {
              "value": "impacts",
              "text": "Impacts Hub"
            },
            {
              "value": "noble",
              "text": "Noble"
            },
            "cosmos",
            {
              "value": "polygon",
              "text": "Polygon"
            }
          ],
          "showOtherItem": true,
          "otherPlaceholder": "Ensure this network is supported",
          "otherText": "Other (specify)",
          "placeholder": "Network...",
          "choicesMin": 1,
          "choicesMax": 1
        }
      ],
      "title": "Payment Details",
      "description": "Please ensure these are correct!"
    },
    {
      "name": "page4",
      "elements": [
        {
          "type": "file",
          "name": "documents",
          "visibleIf": "{documentation} = true",
          "title": "Supporting Documents",
          "description": "Max 1.2 MB",
          "isRequired": true,
          "showCommentArea": true,
          "commentText": "Comments (optional)",
          "allowMultiple": true,
          "waitForUpload": true,
          "maxSize": 1248588,
          "needConfirmRemoveFile": true,
          "sourceType": "file-camera"
        },
        {
          "type": "comment",
          "name": "notes",
          "title": "Notes",
          "description": "Any other information or requests you may wish to submit"
        }
      ],
      "title": "Additional Information",
      "description": "Supporting this Request"
    }
  ]
}