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<div class="control-group ticket_section"> <label class=" required control-label cf_product_category405570_2077101-label " for="helpdesk_ticket_cf_product_category405570_2077101">Product category</label> <div class="controls nested_field "> <select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_product_category405570_2077101_73000772627" name="helpdesk_ticket[custom_field][cf_product_category405570_2077101]"><option value="">...</option> <option value="iPhone Cases">iPhone Cases</option> <option value="MacBook cases">MacBook cases</option> <option value="Smartphone cases (non-Apple devices)">Smartphone cases (non-Apple devices)</option> <option value="iPad/Tablets">iPad/Tablets</option> <option value="Screen Protection">Screen Protection</option> <option value="Bags/Sleeves">Bags/Sleeves</option> <option value="AirPods Cases Pro">AirPods Cases Pro</option> <option value="AirPods (1st/2nd Generation)">AirPods (1st/2nd Generation)</option> <option value="AirPods (3rd Generation)">AirPods (3rd Generation)</option> <option value="Audio">Audio</option> <option value="Accessories">Accessories</option></select><div class="level_2"><label class="required">Device</label><select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_device572461_2077101_73000772627" name="helpdesk_ticket[custom_field][cf_device572461_2077101]"><option value="">...</option> </select></div><div class="level_3"><label class="required">Model</label><select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_model_2077101_73000772627" name="helpdesk_ticket[custom_field][cf_model_2077101]"><option value="">...</option> </select></div><script> //<![CDATA[ jQuery('#helpdesk_ticket_custom_field_cf_product_category405570_2077101_73000772627').nested_select_tag({"data_tree":[["iPhone Cases","iPhone Cases",[["iPhone 16 Pro Max","iPhone 16 Pro Max",[]],["iPhone 16 Pro","iPhone 16 Pro",[]],["iPhone 16 Plus","iPhone 16 Plus",[]],["iPhone 16","iPhone 16",[]],["iPhone 15 Pro Max","iPhone 15 Pro Max",[]],["iPhone 15 Pro","iPhone 15 Pro",[]],["iPhone 15 Plus","iPhone 15 Plus",[]],["iPhone 15","iPhone 15",[]],["iPhone 14 Pro Max","iPhone 14 Pro Max",[]],["iPhone 14 Pro","iPhone 14 Pro",[]],["iPhone 14 Plus","iPhone 14 Plus",[]],["iPhone 14","iPhone 14",[]],["iPhone 13 Pro","iPhone 13 Pro",[]],["iPhone 13 Pro Max","iPhone 13 Pro Max",[]],["iPhone 13","iPhone 13",[]],["iPhone 13 mini","iPhone 13 mini",[]],["iPhone SE","iPhone SE",[]],["iPhone 12/12 Pro","iPhone 12/12 Pro",[]],["iPhone 12 Pro Max","iPhone 12 Pro Max",[]],["iPhone 12 mini","iPhone 12 mini",[]],["iPhone 11","iPhone 11",[]],["iPhone 11 Pro","iPhone 11 Pro",[]],["iPhone 11 Pro Max","iPhone 11 Pro Max",[]],["iPhone XS","iPhone XS",[]],["iPhone XS Max","iPhone XS Max",[]],["iPhone XR","iPhone XR",[]],["iPhone X","iPhone X",[]],["iPhone 5/5s","iPhone 5/5s",[]],["iPhone 8/7/6 Plus","iPhone 8/7/6 Plus",[]],["IPHONE 8","IPHONE 8",[]],["IPHONE 7","IPHONE 7",[]],["IPHONE 6S","IPHONE 6S",[]]]],["MacBook cases","MacBook cases",[["Universal Fit (15\"-16\" Laptop)","Universal Fit (15\"-16\" Laptop)",[]],["Universal Fit (13\"-14\" Laptop)","Universal Fit (13\"-14\" Laptop)",[]],["MacBook Pro 16\" (2021)","MacBook Pro 16\" (2021)",[]],["Macbook Pro 16 (2021-2023)","Macbook Pro 16 (2021-2023)",[]],["MacBook Pro 14“(2021-2023)","MacBook Pro 14“(2021-2023)",[]],["Macbook Pro 13 M2 (2022)","Macbook Pro 13 M2 (2022)",[]],["MacBook Air 13 M2","MacBook Air 13 M2",[]],["MacBook Pro W/ Retina Display 13\"","MacBook Pro W/ Retina Display 13\"",[]]]],["Smartphone cases (non-Apple devices)","Smartphone cases (non-Apple devices)",[["Samsung","Samsung",[["Galaxy Z Fold 6/Galaxy Z Flip6","Galaxy Z Fold 6/Galaxy Z Flip6"],["Galaxy Z Fold5 / Galaxy Z Flip5","Galaxy Z Fold5 / Galaxy Z Flip5"],["Galaxy Z Fold4 / Galaxy Z Flip4","Galaxy Z Fold4 / Galaxy Z Flip4"],["Galaxy Z Fold3 / Galaxy Z Flip3","Galaxy Z Fold3 / Galaxy Z Flip3"],["Galaxy S24 Ultra","Galaxy S24 Ultra"],["Galaxy S24 +","Galaxy S24 +"],["Galaxy S24","Galaxy S24"],["Galaxy S23","Galaxy S23"],["Galaxy S23 +","Galaxy S23 +"],["Galaxy S23 Ultra","Galaxy S23 Ultra"],["Galaxy S22","Galaxy S22"],["Galaxy S22+","Galaxy S22+"],["Galaxy S22 Ultra","Galaxy S22 Ultra"],["Galaxy S21 5G","Galaxy S21 5G"],["Galaxy S21+ 5G","Galaxy S21+ 5G"],["Galaxy S21 Ultra 5G","Galaxy S21 Ultra 5G"],["Galaxy S20","Galaxy S20"],["Galaxy S20 FE 5G","Galaxy S20 FE 5G"],["Galaxy S20+","Galaxy S20+"],["Galaxy S20 Ultra","Galaxy S20 Ultra"],["Galaxy S10e","Galaxy S10e"],["Galaxy S10","Galaxy S10"],["Galaxy S10+","Galaxy S10+"],["Galaxy Note 20","Galaxy Note 20"],["Galaxy Note 20 Ultra","Galaxy Note 20 Ultra"],["Galaxy Note10","Galaxy Note10"],["Galaxy Note10+","Galaxy Note10+"],["Galaxy A71","Galaxy A71"],["Galaxy A71 5G","Galaxy A71 5G"],["Galaxy A71 5G UW","Galaxy A71 5G UW"],["Galaxy A54 5G","Galaxy A54 5G"],["Galaxy A53 5G","Galaxy A53 5G"],["Galaxy A52 5G","Galaxy A52 5G"],["Galaxy A51 5G","Galaxy A51 5G"],["Galaxy A50","Galaxy A50"],["Galaxy A42 5G","Galaxy A42 5G"],["Galaxy A23 5G","Galaxy A23 5G"],["Galaxy A23 5G UW","Galaxy A23 5G UW"],["Galaxy A20","Galaxy A20"],["Galaxy A14 5G","Galaxy A14 5G"],["Galaxy A13","Galaxy A13"],["Galaxy A13 5G","Galaxy A13 5G"],["Galaxy A12","Galaxy A12"],["Galaxy A11","Galaxy A11"],["Galaxy A10e","Galaxy A10e"],["Galaxy A03s","Galaxy A03s"],["Galaxy A02s","Galaxy A02s"],["Galaxy A01","Galaxy A01"]]],["Google","Google",[["Pixel 8a","Pixel 8a"],["Pixel 8","Pixel 8"],["Pixel 8 Pro","Pixel 8 Pro"],["Pixel 7a","Pixel 7a"],["Pixel 7","Pixel 7"],["Pixel 7 Pro","Pixel 7 Pro"],["Pixel 6a","Pixel 6a"],["Pixel 5","Pixel 5"],["Pixel 4","Pixel 4"],["Pixel 4a","Pixel 4a"],["Pixel 4a 5G","Pixel 4a 5G"],["Pixel 4a 5G / UW","Pixel 4a 5G / UW"],["Pixel 4 XL","Pixel 4 XL"],["Pixel 3a","Pixel 3a"],["Pixel 3a XL","Pixel 3a XL"],["Pixel 3","Pixel 3"],["Pixel 3 XL","Pixel 3 XL"],["Pixel 2","Pixel 2"],["Pixel Fold","Pixel Fold"]]],["LG","LG",[["LG G8 ThinQ","LG G8 ThinQ"],["LG G7 ThinQ","LG G7 ThinQ"],["LG G6","LG G6"],["LG Velvet","LG Velvet"],["LG Stylo 6","LG Stylo 6"],["LG Stylo 5","LG Stylo 5"],["LG K92 5G","LG K92 5G"],["LG V60 ThinQ","LG V60 ThinQ"],["LG V50 ThinQ","LG V50 ThinQ"],["LG Q70","LG Q70"]]],["One Plus","One Plus",[["N300 5G","N300 5G"],["OnePlus 8","OnePlus 8"],["OnePlus 8 5G","OnePlus 8 5G"],["OnePlus 8 5G UW","OnePlus 8 5G UW"],["OnePlus 7T","OnePlus 7T"],["OnePlus 7 Pro","OnePlus 7 Pro"],["Nord N20 5G","Nord N20 5G"]]],["Motorola","Motorola",[["Power G 5G 2023","Power G 5G 2023"],["Edge 2022","Edge 2022"],["Edge+","Edge+"],["One 5G","One 5G"],["One 5G Ace","One 5G Ace"],["Moto Z4","Moto Z4"],["Moto Z3 Play","Moto Z3 Play"],["Moto Z Play","Moto Z Play"],["Moto Z Force Droid Edition","Moto Z Force Droid Edition"],["Moto E","Moto E"],["Moto E6","Moto E6"],["Moto G7 Power","Moto G7 Power"],["Moto G7 Play","Moto G7 Play"],["Moto G5 Plus","Moto G5 Plus"],["Moto G Stylus","Moto G Stylus"],["Moto G Stylus 5G","Moto G Stylus 5G"],["Moto G Play","Moto G Play"],["Moto Droid Maxx","Moto Droid Maxx"]]],["TCL","TCL",[["Ion X","Ion X"],["Ion Z","Ion Z"],["30XE 5G","30XE 5G"],["TCL 10","TCL 10"],["TCL 10L","TCL 10L"],["TCL 10 5G","TCL 10 5G"],["TCL 10 Pro","TCL 10 Pro"],["Stylus 5G","Stylus 5G"]]],["Sony","Sony",[["Xperia 10","Xperia 10"],["Xperia 10 Plus","Xperia 10 Plus"]]],["HTC","HTC",[["One M9","One M9"]]],["Nokia","Nokia",[["G400 5G","G400 5G"]]],["Alcatel","Alcatel",[["Alcatel Axel","Alcatel Axel"]]],["T-Mobile","T-Mobile",[["REVVL 6 PRO 5G","REVVL 6 PRO 5G"],["REVVL 6 5G","REVVL 6 5G"],["WIKO VOIX","WIKO VOIX"]]],["Cricket","Cricket",[["Icon 4","Icon 4"],["Ovation 3","Ovation 3"],["Innovate E 5G","Innovate E 5G"],["Cricket Debut","Cricket Debut"]]],["AT&T","AT&T",[["Fusion Z","Fusion Z"],["Radiant Max","Radiant Max"],["Radiant Max 5G","Radiant Max 5G"]]]]],["iPad/Tablets","iPad/Tablets",[["Apple","Apple",[["IPAD AIR 13-INCH (2024)","IPAD AIR 13-INCH (2024)"],["IPAD PRO 13-INCH (2024)","IPAD PRO 13-INCH (2024)"],["IPAD AIR 11-INCH (2024)","IPAD AIR 11-INCH (2024)"],["IPAD PRO 11-INCH (2024)","IPAD PRO 11-INCH (2024)"],["12.9 IPAD PRO (2022)","12.9 IPAD PRO (2022)"],["12.9 IPAD PRO (2018-2021)","12.9 IPAD PRO (2018-2021)"],["12.9 IPAD PRO (2017)","12.9 IPAD PRO (2017)"],["11 IPAD PRO (2022)","11 IPAD PRO (2022)"],["11 IPAD PRO (2018-2021)","11 IPAD PRO (2018-2021)"],["10.9 IPAD","10.9 IPAD"],["10.5 IPAD","10.5 IPAD"],["10.2 IPAD","10.2 IPAD"],["9.7 IPAD","9.7 IPAD"],["IPAD Air (2019)","IPAD Air (2019)"],["IPAD Air 3rd Gen","IPAD Air 3rd Gen"],["IPAD Mini (5th/4th Gen)","IPAD Mini (5th/4th Gen)"]]],["Samsung","Samsung",[["TAB S8 Ultra","TAB S8 Ultra"],["TAB S8+","TAB S8+"],["TAB S7+","TAB S7+"],["TAB S8/S7","TAB S8/S7"],["TAB S4","TAB S4"],["Galaxy S5e","Galaxy S5e"],["TAB A 8.4","TAB A 8.4"],["TAB A8","TAB A8"],["TAB A7 Lite","TAB A7 Lite"]]],["Google","Google",[["Pixel Tablet","Pixel Tablet"]]],["TCL","TCL",[["TAB 8","TAB 8"],["TAB 8 LE","TAB 8 LE"]]],["Alcatel","Alcatel",[["Joy Tab2","Joy Tab2"]]],["Asus","Asus",[["ZenPad Z8s","ZenPad Z8s"]]],["Verizon","Verizon",[["Ellipsis 8","Ellipsis 8"]]],["T-Mobile","T-Mobile",[["Moxee","Moxee"]]],["Kindle","Kindle",[["Fire HDX 8.9","Fire HDX 8.9"]]]]],["Screen Protection","Screen Protection",[["Apple","Apple",[["iPhone 16 Pro Max","iPhone 16 Pro Max"],["iPhone 16 Plus","iPhone 16 Plus"],["iPhone 16 Pro","iPhone 16 Pro"],["iPhone 16","iPhone 16"],["iPhone 15 Pro Max","iPhone 15 Pro Max"],["iPhone 15 Plus","iPhone 15 Plus"],["iPhone 15 Pro","iPhone 15 Pro"],["iPhone 15","iPhone 15"],["iPhone 14","iPhone 14"],["iPhone 14 Pro","iPhone 14 Pro"],["iPhone 14 Plus","iPhone 14 Plus"],["iPhone 14 Pro Max","iPhone 14 Pro Max"],["iPhone 13 Mini","iPhone 13 Mini"],["iPhone 13/ 13Pro","iPhone 13/ 13Pro"],["iPhone 13 Pro Max","iPhone 13 Pro Max"],["iPhone 12 Mini","iPhone 12 Mini"],["iPhone 12/12 Pro","iPhone 12/12 Pro"],["iPhone 12 Pro Max","iPhone 12 Pro Max"],["iPhone 11 / iPhone XR","iPhone 11 / iPhone XR"],["iPhone 11 Pro Max / iPhone XS Max","iPhone 11 Pro Max / iPhone XS Max"],["iPhone SE (2022/2020) / iPhone 8","iPhone SE (2022/2020) / iPhone 8"]]],["Samsung","Samsung",[["Galaxy A54 5G","Galaxy A54 5G"],["Galaxy A53 5G","Galaxy A53 5G"],["Galaxy A23 5G","Galaxy A23 5G"],["Galaxy A14 5G","Galaxy A14 5G"],["Galaxy A13 5G","Galaxy A13 5G"],["Galaxy A13 4G","Galaxy A13 4G"],["Galaxy A03s","Galaxy A03s"],["Galaxy S10e","Galaxy S10e"]]],["Google","Google",[["Pixel Tablet","Pixel Tablet"]]],["OnePlus","OnePlus",[["Nord N20 5G","Nord N20 5G"],["N300 5G","N300 5G"]]],["Motorola","Motorola",[["Moto G Play 2023","Moto G Play 2023"],["Moto G 5G 2022","Moto G 5G 2022"],["Moto G Pure","Moto G Pure"]]],["TCL","TCL",[["Ion X","Ion X"],["Ion Z","Ion Z"]]],["Nokia","Nokia",[["G400 5G","G400 5G"]]],["Cricket","Cricket",[["Icon 4","Icon 4"],["Ovation 3","Ovation 3"],["Innovate E 5G","Innovate E 5G"],["Cricket Debut","Cricket Debut"]]],["T-Mobile","T-Mobile",[["Wiko Voix","Wiko Voix"],["RVVL 6 Pro 5G","RVVL 6 Pro 5G"],["RVVL 6 5G","RVVL 6 5G"]]]]],["Bags/Sleeves","Bags/Sleeves",[["Backpacks","Backpacks",[]],["MightyVault","MightyVault",[]],["Transfer Pro-Pocket Universal (15\"-16\" Laptop)","Transfer Pro-Pocket Universal (15\"-16\" Laptop)",[]],["Transfer Pro-Pocket Universal (13\"-14\" Laptop)","Transfer Pro-Pocket Universal (13\"-14\" Laptop)",[]],["TRANSFER PRO 30L BACKPACK","TRANSFER PRO 30L BACKPACK",[]],["TRANSFER PRO 26L BACKPACK","TRANSFER PRO 26L BACKPACK",[]],["DEADLINE BACKPACK","DEADLINE BACKPACK",[]]]],["AirPods Cases Pro","AirPods Cases Pro",[["Presidio Clickflip","Presidio Clickflip",[]],["Presidio Clear","Presidio Clear",[]],["Presidio With Soft-Touch Coating","Presidio With Soft-Touch Coating",[]],["Presidio Pro","Presidio Pro",[]],["Presidio Perfect-Clear","Presidio Perfect-Clear",[]]]],["AirPods (1st/2nd Generation)","AirPods (1st/2nd Generation)",[["CandyShell","CandyShell",[]],["Presidio With Soft-Touch Coating","Presidio With Soft-Touch Coating",[]],["Presidio Clear","Presidio Clear",[]],["Presidio Pro","Presidio Pro",[]],["Presidio Clear + Glitter","Presidio Clear + Glitter",[]]]],["AirPods (3rd Generation)","AirPods (3rd Generation)",[["Presidio with Soft-Touch Coating","Presidio with Soft-Touch Coating",[]],["Presidio Clear","Presidio Clear",[]]]],["Audio","Audio",[["GEMTONES SPORT TRUE WIRELESS EARBUDS","GEMTONES SPORT TRUE WIRELESS EARBUDS",[]],["GEMTONES PLAY TRUE WIRELESS EARBUDS","GEMTONES PLAY TRUE WIRELESS EARBUDS",[]],["GEMTONES PRO TRUE WIRELESS EARBUDS","GEMTONES PRO TRUE WIRELESS EARBUDS",[]],["Gemtones Infinity Max Bluetooth Speaker","Gemtones Infinity Max Bluetooth Speaker",[]],["Gemtones Infinity Mid Bluetooth Speaker","Gemtones Infinity Mid Bluetooth Speaker",[]],["Gemtones Infinity Mini Bluetooth Speaker","Gemtones Infinity Mini Bluetooth Speaker",[]]]],["Accessories","Accessories",[["GRABTAB","GRABTAB",[]],["LOOTLOCK","LOOTLOCK",[]],["Presidio Mount","Presidio Mount",[]],["Presidio Mount + MagicMount","Presidio Mount + MagicMount",[]],["Airtags","Airtags",[["SiliLoop","SiliLoop"],["SILIRING","SILIRING"],["CARABINER","CARABINER"],["LUGGAGE TAG PRO","LUGGAGE TAG PRO"],["TAGIMALS SHOE CARRIERS FOR AIRTAG","TAGIMALS SHOE CARRIERS FOR AIRTAG"]]],["Magsafe","Magsafe",[["WALLET FOR MAGSAFE WITH CLICKLOCK","WALLET FOR MAGSAFE WITH CLICKLOCK"],["CAR VENT MOUNT FOR MAGSAFE WITH CLICKLOCK","CAR VENT MOUNT FOR MAGSAFE WITH CLICKLOCK"],["STANDYGRIP FOR MAGSAFE STAND AND GRIP COMBO WITH CLICKLOCK","STANDYGRIP FOR MAGSAFE STAND AND GRIP COMBO WITH CLICKLOCK"]]],["WALLET FOR MAGSAFE WITH CLICKLOCK","WALLET FOR MAGSAFE WITH CLICKLOCK",[]],["CAR VENT MOUNT FOR MAGSAFE WITH CLICKLOCK","CAR VENT MOUNT FOR MAGSAFE WITH CLICKLOCK",[]],["STANDYGRIP FOR MAGSAFE STAND AND GRIP COMBO WITH CLICKLOCK","STANDYGRIP FOR MAGSAFE STAND AND GRIP COMBO WITH CLICKLOCK",[]],["Presidio Pro Folio for Magsafe","Presidio Pro Folio for Magsafe",[]]]]],"initValues":null,"disable_children":false,"include_blank":"...","selected":null,"pl_value_id":"73000772627","subcategory_id":"helpdesk_ticket_custom_field_cf_device572461_2077101_73000772627","item_id":"helpdesk_ticket_custom_field_cf_model_2077101_73000772627"}); //]]> </script> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_color875887_2077101-label " for="helpdesk_ticket_cf_color875887_2077101">Color</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_color875887_2077101]" id="helpdesk_ticket_custom_field_cf_color875887_2077101" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_part_number_2077101-label " for="helpdesk_ticket_cf_part_number_2077101">Item number</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_part_number_2077101]" id="helpdesk_ticket_custom_field_cf_part_number_2077101" /> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_reason_for_claim752653_2077101-label " for="helpdesk_ticket_cf_reason_for_claim752653_2077101">Reason for claim</label> <div class="controls "> <select class=" required dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_reason_for_claim752653_2077101]" id="helpdesk_ticket_custom_field_cf_reason_for_claim752653_2077101"><option value="">...</option> <option data-id="73000784633" value="Grip peeling">Grip peeling</option> <option data-id="73000784634" value="Buttons issue">Buttons issue</option> <option data-id="73000784635" value="Discoloration/Stained">Discoloration/Stained</option> <option data-id="73000784636" value="Fit issue">Fit issue</option> <option data-id="73000784637" value="Crack/Shattered">Crack/Shattered</option> <option data-id="73000784638" value="Missing or broken parts">Missing or broken parts</option> <option data-id="73000784639" value="Does not work">Does not work</option> <option data-id="73000784640" value="Other">Other</option> <option data-id="73000828578" value="Damaged Phone">Damaged Phone</option> <option data-id="73000846888" value="Warped">Warped</option> <option data-id="73000846889" value="Broken bridge">Broken bridge</option> <option data-id="73000980130" value="Coat Peeling">Coat Peeling</option> <option data-id="73000990434" value="Lost Package">Lost Package</option> <option data-id="73000990665" value="Zipper Damaged">Zipper Damaged</option> <option data-id="73001035886" value="Loose Magsafe">Loose Magsafe</option></select> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_purchase_date209801_2077101-label " for="helpdesk_ticket_cf_purchase_date209801_2077101">When did you purchase the product?</label> <div class="controls support-date-field "> <input type="text" name="helpdesk_ticket[custom_field][cf_purchase_date209801_2077101]" id="helpdesk_ticket_custom_field_cf_purchase_date209801_2077101" class=" required date section_field datepicker_popover" readonly="readonly" data-show-image="true" data-date-format="d M, yy" placeholder="" /> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_purchase_location_2077101-label " for="helpdesk_ticket_cf_purchase_location_2077101">Where did you purchase the product?</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_purchase_location_2077101]" id="helpdesk_ticket_custom_field_cf_purchase_location_2077101" /> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_first_name_2077101-label " for="helpdesk_ticket_cf_first_name_2077101">Shipping First name</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_first_name_2077101]" id="helpdesk_ticket_custom_field_cf_first_name_2077101" /> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_last_name304016_2077101-label " for="helpdesk_ticket_cf_last_name304016_2077101">Shipping last name</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_last_name304016_2077101]" id="helpdesk_ticket_custom_field_cf_last_name304016_2077101" /> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_shipping_address_2077101-label " for="helpdesk_ticket_cf_shipping_address_2077101">Shipping Address 1</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_shipping_address_2077101]" id="helpdesk_ticket_custom_field_cf_shipping_address_2077101" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_shipping_address_2_2077101-label " for="helpdesk_ticket_cf_shipping_address_2_2077101">Shipping Address 2</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_shipping_address_2_2077101]" id="helpdesk_ticket_custom_field_cf_shipping_address_2_2077101" /> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_city270206_2077101-label " for="helpdesk_ticket_cf_city270206_2077101">Shipping City</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_city270206_2077101]" id="helpdesk_ticket_custom_field_cf_city270206_2077101" /> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_state504743_2077101-label " for="helpdesk_ticket_cf_state504743_2077101">Shipping State</label> <div class="controls "> <select class=" required dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_state504743_2077101]" id="helpdesk_ticket_custom_field_cf_state504743_2077101"><option value="">...</option> <option data-id="73000784641" value="AL">AL</option> <option data-id="73000784642" value="AK">AK</option> <option data-id="73000784643" value="AZ">AZ</option> <option data-id="73000784644" value="AR">AR</option> <option data-id="73000784645" value="CA">CA</option> <option data-id="73000784646" value="CO">CO</option> <option data-id="73000784647" value="CT">CT</option> <option data-id="73000839816" value="DC">DC</option> <option data-id="73000784648" value="DE">DE</option> <option data-id="73000784649" value="FL">FL</option> <option data-id="73000784650" value="GA">GA</option> <option data-id="73000784651" value="HI">HI</option> <option data-id="73000784652" value="ID">ID</option> <option data-id="73000784653" value="IL">IL</option> <option data-id="73000784654" value="IN">IN</option> <option data-id="73000784655" value="IA">IA</option> <option data-id="73000784656" value="KS">KS</option> <option data-id="73000784657" value="KY">KY</option> <option data-id="73000784658" value="LA">LA</option> <option data-id="73000784659" value="ME">ME</option> <option data-id="73000784660" value="MD">MD</option> <option data-id="73000784661" value="MA">MA</option> <option data-id="73000784662" value="MI">MI</option> <option data-id="73000784663" value="MN">MN</option> <option data-id="73000784664" value="MS">MS</option> <option data-id="73000784665" value="MO">MO</option> <option data-id="73000784666" value="MT">MT</option> <option data-id="73000784667" value="NE">NE</option> <option data-id="73000784668" value="NV">NV</option> <option data-id="73000784669" value="NH">NH</option> <option data-id="73000784670" value="NJ">NJ</option> <option data-id="73000784671" value="NM">NM</option> <option data-id="73000784672" value="NY">NY</option> <option data-id="73000784673" value="NC">NC</option> <option data-id="73000784674" value="ND">ND</option> <option data-id="73000784675" value="OH">OH</option> <option data-id="73000784676" value="OK">OK</option> <option data-id="73000784677" value="OR">OR</option> <option data-id="73000784678" value="PA">PA</option> <option data-id="73000874516" value="PR">PR</option> <option data-id="73000784679" value="RI">RI</option> <option data-id="73000784680" value="SC">SC</option> <option data-id="73000784681" value="SD">SD</option> <option data-id="73000784682" value="TN">TN</option> <option data-id="73000784683" value="TX">TX</option> <option data-id="73000784684" value="UT">UT</option> <option data-id="73000784685" value="VT">VT</option> <option data-id="73000784686" value="VA">VA</option> <option data-id="73000784687" value="WA">WA</option> <option data-id="73000784688" value="WV">WV</option> <option data-id="73000784689" value="WI">WI</option> <option data-id="73000784690" value="WY">WY</option></select> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_zip_code762590_2077101-label " for="helpdesk_ticket_cf_zip_code762590_2077101">Shipping Zip Code</label> <div class="controls "> <input class=" required number section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_zip_code762590_2077101]" id="helpdesk_ticket_custom_field_cf_zip_code762590_2077101" /> </div> </div>
<div class="control-group ticket_section"> <label class=" required control-label cf_reason_for_return_2077101-label " for="helpdesk_ticket_cf_reason_for_return_2077101">Reason for return</label> <div class="controls "> <select class=" required dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_reason_for_return_2077101]" id="helpdesk_ticket_custom_field_cf_reason_for_return_2077101"><option value="">...</option> <option data-id="73000791906" value="The Customer Bought the Wrong Item">The Customer Bought the Wrong Item</option> <option data-id="73000791907" value="The Product is No Longer Needed">The Product is No Longer Needed</option> <option data-id="73000797784" value="The Product Didn't Match the Description">The Product Didn't Match the Description</option> <option data-id="73000797785" value="Not satisfied with the quality">Not satisfied with the quality</option> <option data-id="73000797786" value="The Product Was Damaged Upon Arrival">The Product Was Damaged Upon Arrival</option> <option data-id="73000797787" value="Defective/Does not work properly">Defective/Does not work properly</option> <option data-id="73000797788" value="Product did not fit">Product did not fit</option> <option data-id="73000980129" value="Duplicate order">Duplicate order</option></select> </div> </div>
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