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diff --git a/extensions/BMO/template/en/default/bug/create/comment-screen-share-whitelist.txt.tmpl b/extensions/BMO/template/en/default/bug/create/comment-screen-share-whitelist.txt.tmpl
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+[%# This Source Code Form is subject to the terms of the Mozilla Public
+ # License, v. 2.0. If a copy of the MPL was not distributed with this
+ # file, You can obtain one at http://mozilla.org/MPL/2.0/.
+ #
+ # This Source Code Form is "Incompatible With Secondary Licenses", as
+ # defined by the Mozilla Public License, v. 2.0.
+ #%]
+
+[% USE Bugzilla %]
+[% cgi = Bugzilla.cgi +%]
+>> Vendor name
+[%+ cgi.param('vendor') %]
+
+>> Point of contact
+[%+ cgi.param("contact") %]
+
+>> Site URLs
+[%+ cgi.param("site_urls") %]
+
+>> Does the application provide users with notice and control?
+[%+ cgi.param("notice") %]
+
+>> Have you seen and agree with the Developer Screen Sharing Submission policy?
+[%+ cgi.param("compliance_agreement") %]
+
+>> Does the usage comply with the Developer Screen Sharing Submission Policy guidelines?
+[%+ cgi.param("compliance_usage") %]