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<?xml version="1.0" encoding="utf-8"?> <!-- Generator: Adobe Illustrator 23.1.0, SVG Export Plug-In . SVG Version: 6.00 Build 0) --> <svg version="1.1" id="Layer_1" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" x="0px" y="0px" viewBox="0 0 265 300" enable-background="new 0 0 265 300" xml:space="preserve"> <g id="Group_72" transform="translate(-1258 -2543)"> <path id="Rectangle_1019" fill="#FFFFFF" d="M1263,2543h255c2.8,0,5,2.2,5,5v290c0,2.8-2.2,5-5,5h-255c-2.8,0-5-2.2-5-5v-290 C1258,2545.2,1260.2,2543,1263,2543z"/> <path id="Rectangle_1020" fill="#E5E9EA" d="M1300.5,2602h80c1.4,0,2.5,1.1,2.5,2.5l0,0c0,1.4-1.1,2.5-2.5,2.5h-80 c-1.4,0-2.5-1.1-2.5-2.5l0,0C1298,2603.1,1299.1,2602,1300.5,2602z"/> <path id="Rectangle_1021" fill="#E5E9EA" d="M1300.5,2646h180c1.4,0,2.5,1.1,2.5,2.5l0,0c0,1.4-1.1,2.5-2.5,2.5h-180 c-1.4,0-2.5-1.1-2.5-2.5l0,0C1298,2647.1,1299.1,2646,1300.5,2646z"/> <path id="Rectangle_1022" fill="#E5E9EA" d="M1400.5,2602h80c1.4,0,2.5,1.1,2.5,2.5l0,0c0,1.4-1.1,2.5-2.5,2.5h-80 c-1.4,0-2.5-1.1-2.5-2.5l0,0C1398,2603.1,1399.1,2602,1400.5,2602z"/> <text transform="matrix(1 0 0 1 1298 2594)" fill="#565656" font-family="'HelveticaNeue'" font-size="12px">First Name</text> <text transform="matrix(1 0 0 1 1298 2638)" fill="#565656" font-family="'HelveticaNeue'" font-size="12px">Email</text> <text transform="matrix(1 0 0 1 1298 2692)" fill="#565656" font-family="'HelveticaNeue'" font-size="12px">How would you rate your</text> <text transform="matrix(1 0 0 1 1298 2707)" fill="#565656" font-family="'HelveticaNeue'" font-size="12px">experience with us?</text> <text transform="matrix(1 0 0 1 1398 2594)" fill="#565656" font-family="'HelveticaNeue'" font-size="12px">Last Name</text> <path id="Rectangle_1023" fill="#A08DC2" d="M1343,2781h95c2.8,0,5,2.2,5,5v17c0,2.8-2.2,5-5,5h-95c-2.8,0-5-2.2-5-5v-17 C1338,2783.2,1340.2,2781,1343,2781z"/> <text transform="matrix(1 0 0 1 1371.8301 2799)" fill="#FFFFFF" font-family="'HelveticaNeue-Medium'" font-size="10px">SUBMIT</text> <path id="Rectangle_1024" fill="#E5E9EA" d="M1300.5,2719h5c1.4,0,2.5,1.1,2.5,2.5l0,0c0,1.4-1.1,2.5-2.5,2.5h-5 c-1.4,0-2.5-1.1-2.5-2.5l0,0C1298,2720.1,1299.1,2719,1300.5,2719z"/> <path id="Rectangle_1028" fill="#E5E9EA" d="M1300.5,2753h5c1.4,0,2.5,1.1,2.5,2.5l0,0c0,1.4-1.1,2.5-2.5,2.5h-5 c-1.4,0-2.5-1.1-2.5-2.5l0,0C1298,2754.1,1299.1,2753,1300.5,2753z"/> <path id="Rectangle_1025" fill="#E5E9EA" d="M1300.5,2736h5c1.4,0,2.5,1.1,2.5,2.5l0,0c0,1.4-1.1,2.5-2.5,2.5h-5 c-1.4,0-2.5-1.1-2.5-2.5l0,0C1298,2737.1,1299.1,2736,1300.5,2736z"/> <path id="Rectangle_1026" fill="#E5E9EA" d="M1320.5,2719h35c1.4,0,2.5,1.1,2.5,2.5l0,0c0,1.4-1.1,2.5-2.5,2.5h-35 c-1.4,0-2.5-1.1-2.5-2.5l0,0C1318,2720.1,1319.1,2719,1320.5,2719z"/> <path id="Rectangle_1029" fill="#E5E9EA" d="M1320.5,2753h75c1.4,0,2.5,1.1,2.5,2.5l0,0c0,1.4-1.1,2.5-2.5,2.5h-75 c-1.4,0-2.5-1.1-2.5-2.5l0,0C1318,2754.1,1319.1,2753,1320.5,2753z"/> <path id="Rectangle_1027" fill="#E5E9EA" d="M1320.5,2736h55c1.4,0,2.5,1.1,2.5,2.5l0,0c0,1.4-1.1,2.5-2.5,2.5h-55 c-1.4,0-2.5-1.1-2.5-2.5l0,0C1318,2737.1,1319.1,2736,1320.5,2736z"/> </g> </svg>
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