chrome/browser/resources/md_feedback/feedback_container.html

<link rel="import" href="chrome://resources/html/polymer.html">
<link rel="import" href="chrome://resources/polymer/v1_0/paper-button/paper-button.html">
<link rel="import" href="chrome://resources/polymer/v1_0/paper-checkbox/paper-checkbox.html">
<link rel="import" href="chrome://resources/polymer/v1_0/paper-input/paper-input.html">
<link rel="import" href="chrome://resources/polymer/v1_0/paper-input/paper-textarea.html">
<dom-module name="feedback-container">
  <template>
    <style>
      #additional-info {
        margin-top: 10px;
      }

      #buttons {
        display: -webkit-flex;
        justify-content: flex-end;
      }

      #header {
        font-size: 1.25em;
        margin: 12px 0;
      }

      paper-button {
        cursor: pointer;
        text-align: center;
      }

      paper-checkbox {
        --paper-checkbox-size: 14px;
      }

      paper-input,
      paper-textarea {
        --paper-input-container-input: {
          font-size: 1.0em;
          line-height: 1.0em;
        };
        --paper-input-container-label: {
          font-size: 1.0em;
          line-height: 1.0em;
        };
      }

      paper-input-container {
        padding: 0;
      }

      #submit-button {
        color: var(--paper-blue-700);
      }
    </style>
    <div id="header">
      <span>$i18n{headingText}</span>
    </div>
    <hr>
    <paper-textarea label="$i18n{openEndedLabel}"></paper-textarea>
    <span id="additional-info">$i18n{additionalInfoLabel}</span>
    <paper-input label="$i18n{urlLabel}" value="[[url]]"></paper-input>
    <paper-input label="$i18n{emailLabel}" value="[[email]]"></paper-input>
    <div>
      <paper-checkbox>$i18n{includeScreenshotLabel}</paper-checkbox>
    </div>
    <div>
      <paper-checkbox>$i18n{sendSystemInfoLabel}</paper-checkbox>
    </div>
    <p id="privacyNote"></p>
    <div id="buttons">
      <paper-button>$i18n{cancelButton}</paper-button>
      <paper-button id="submit-button">$i18n{sendReportButton}</paper-button>
    </div>
  </template>
  <script src="feedback_container.js"></script>
</dom-module>