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<label class=" control-label cf_return_type_1004774-label " for="helpdesk_ticket_cf_return_type_1004774">Return type</label> <div class="controls "> <select class=" dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_return_type_1004774]" id="helpdesk_ticket_custom_field_cf_return_type_1004774"><option value="">...</option> <option data-id="43000839696" value="Partner-Starter kit">Partner-Starter kit</option> <option data-id="43000839697" value="Partner-Other products">Partner-Other products</option> <option data-id="43000839698" value="Customer return">Customer return</option></select> </div>
<label class=" control-label cf_order_number_1004774-label " for="helpdesk_ticket_cf_order_number_1004774">Order number</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_order_number_1004774]" id="helpdesk_ticket_custom_field_cf_order_number_1004774" /> </div>
<div class="controls"> <label class="checkbox required"> <input type="checkbox" name="helpdesk_ticket[custom_field][cf_i_have_checked_that_my_billing_address_matches_my_bank_or_credit_card_billing_address_1004774]" id="helpdesk_ticket_custom_field_cf_i_have_checked_that_my_billing_address_matches_my_bank_or_credit_card_billing_address_1004774_43000899628" value="1" class=" required checkbox section_field" /> I have checked that my billing address matches my bank or credit card billing address. </label> </div>
<div class="controls"> <label class="checkbox required"> <input type="checkbox" name="helpdesk_ticket[custom_field][cf_i_am_the_primary_or_authorized_user_on_the_card_i_am_attempting_to_use_1004774]" id="helpdesk_ticket_custom_field_cf_i_am_the_primary_or_authorized_user_on_the_card_i_am_attempting_to_use_1004774_43000899628" value="1" class=" required checkbox section_field" /> I am the Primary or Authorized User on the card I am attempting to use. </label> </div>
<div class="controls"> <label class="checkbox required"> <input type="checkbox" name="helpdesk_ticket[custom_field][cf_i_am_placing_this_order_for_myself_using_my_account_1004774]" id="helpdesk_ticket_custom_field_cf_i_am_placing_this_order_for_myself_using_my_account_1004774_43000899628" value="1" class=" required checkbox section_field" /> I am placing this order for myself, using my account. </label> </div>
<label class=" required control-label cf_please_enter_the_last_four_digits_of_the_credit_card_you_are_attempting_to_use_1004774-label " for="helpdesk_ticket_cf_please_enter_the_last_four_digits_of_the_credit_card_you_are_attempting_to_use_1004774">Please enter the last four digits of the credit card you are attempting to use.</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_please_enter_the_last_four_digits_of_the_credit_card_you_are_attempting_to_use_1004774]" id="helpdesk_ticket_custom_field_cf_please_enter_the_last_four_digits_of_the_credit_card_you_are_attempting_to_use_1004774" /> </div>
<label class=" required control-label cf_bellame_partner_1004774-label " for="helpdesk_ticket_cf_bellame_partner_1004774">Partner issue</label> <div class="controls nested_field "> <select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_bellame_partner_1004774_43000813829" name="helpdesk_ticket[custom_field][cf_bellame_partner_1004774]"><option value="">...</option> <option value="I have a question about my account.">I have a question about my account.</option> <option value="I need technical help.">I need technical help.</option> <option value="I need help with an existing order.">I need help with an existing order.</option> <option value="I would like to request a feature.">I would like to request a feature.</option></select><div class="level_2"><label class="required">Issue details</label><select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_issue_1004774_43000813829" name="helpdesk_ticket[custom_field][cf_issue_1004774]"><option value="">...</option> </select></div><script> //<![CDATA[ jQuery('#helpdesk_ticket_custom_field_cf_bellame_partner_1004774_43000813829').nested_select_tag({"data_tree":[["I have a question about my account.","I have a question about my account.",[["What is my partner number?","What is my partner number?",[]],["I have a question about commissions.","I have a question about commissions.",[]],["I have another question.","I have another question.",[]]]],["I need technical help.","I need technical help.",[["I need help placing an order.","I need help placing an order.",[]],["I need help with my dashboard.","I need help with my dashboard.",[]],["I need help with my boutique web site.","I need help with my boutique web site.",[]],["I need help with analytics or tracking.","I need help with analytics or tracking.",[]],["I have another question.","I have another question.",[]]]],["I need help with an existing order.","I need help with an existing order.",[["I need help with order status or tracking.","I need help with order status or tracking.",[]],["I have another question.","I have another question.",[]]]],["I would like to request a feature.","I would like to request a feature.",[]]],"initValues":null,"disable_children":false,"include_blank":"...","selected":null,"pl_value_id":"43000813829","subcategory_id":"helpdesk_ticket_custom_field_cf_issue_1004774_43000813829"}); //]]> </script> </div>
<label class=" control-label cf_customer_issue_1004774-label " for="helpdesk_ticket_cf_customer_issue_1004774">Customer issue</label> <div class="controls nested_field "> <select class=" nested_field section_field" id="helpdesk_ticket_custom_field_cf_customer_issue_1004774_43000813832" name="helpdesk_ticket[custom_field][cf_customer_issue_1004774]"><option value="">...</option> <option value="I need technical help.">I need technical help.</option> <option value="I need help with an existing order.">I need help with an existing order.</option></select><div class="level_2"><label class="">Issue details</label><select class=" nested_field section_field" id="helpdesk_ticket_custom_field_cf_issue_details_1004774_43000813832" name="helpdesk_ticket[custom_field][cf_issue_details_1004774]"><option value="">...</option> </select></div><script> //<![CDATA[ jQuery('#helpdesk_ticket_custom_field_cf_customer_issue_1004774_43000813832').nested_select_tag({"data_tree":[["I need technical help.","I need technical help.",[["I need help placing an order.","I need help placing an order.",[]],["I have another question.","I have another question.",[]]]],["I need help with an existing order.","I need help with an existing order.",[["I need help with order status or tracking.","I need help with order status or tracking.",[]],["I have another question.","I have another question.",[]]]]],"initValues":null,"disable_children":false,"include_blank":"...","selected":null,"pl_value_id":"43000813832","subcategory_id":"helpdesk_ticket_custom_field_cf_issue_details_1004774_43000813832"}); //]]> </script> </div>
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