diff --git a/templates/requests/screen-1.html b/templates/requests/screen-1.html
index 34cef91b..f164ada6 100644
--- a/templates/requests/screen-1.html
+++ b/templates/requests/screen-1.html
@@ -64,16 +64,16 @@
-
-
+
+
-
-
+
+
{{ TextInput(f.dollar_value, validation='dollars') }}
{{ TextInput(f.start_date, validation='date', placeholder='MM / DD / YYYY') }}