The source code

    Ext.ns('Ext.app');

    Ext.app.ContactForm = Ext.extend(Ext.FormPanel, {
        formTitle: 'Contact Information (English)',
        firstName: 'First Name',
        lastName: 'Surname',
        surnamePrefix: 'Surname Prefix',
        company: 'Company',
        state: 'State',
        stateEmptyText: 'Choose a state...',
        email: 'E-mail',
        birth: 'Date of Birth',
        save: 'Save',
        cancel: 'Cancel',

        initComponent : function(config) {
            Ext.apply(this, {
                labelWidth: 100, // label settings here cascade unless overridden
                url:'save-form.php',
                frame:true,
                title: this.formTitle,
                bodyStyle:'padding:5px 5px 0',
                width: 370,
                defaults: {width: 220},
                defaultType: 'textfield',

                items: [{
                        fieldLabel: this.firstName,
                        name: 'firstname',
                        allowBlank:false
                    },{
                        fieldLabel: this.lastName,
                        name: 'lastName'
                    },{
                        fieldLabel: this.surnamePrefix,
                        width: 50,
                        name: 'surnamePrefix'
                    },{
                        fieldLabel: this.company,
                        name: 'company'
                    },  new Ext.form.ComboBox({
                        fieldLabel: this.province,
                        hiddenName: 'state',
                        store: new Ext.data.ArrayStore({
                            fields: ['provincie'],
                            data : Ext.exampledata.dutch_provinces // from dutch-provinces.js
                        }),
                        displayField: 'provincie',
                        typeAhead: true,
                        mode: 'local',
                        triggerAction: 'all',
                        emptyText: this.stateEmtyText,
                        selectOnFocus:true,
                        width:190
                    }), {
                        fieldLabel: this.email,
                        name: 'email',
                        vtype:'email'
                    }, new Ext.form.DateField({
                        fieldLabel: this.birth,
                        name: 'birth'
                    })
                ],

                buttons: [{
                    text: this.save
                },{
                    text: this.cancel
                }]
            });

            Ext.app.ContactForm.superclass.initComponent.apply(this, arguments);
        }
    });

    Ext.onReady(function(){
        Ext.QuickTips.init();

        // turn on validation errors beside the field globally
        Ext.form.Field.prototype.msgTarget = 'side';

        var bd = Ext.getBody();

        bd.createChild({tag: 'h2', html: 'Localized Contact Form'});

        // simple form
        var simple = new Ext.app.ContactForm();
        simple.render(document.body);
    });