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<div class="control-group ticket_section">
                     <label class=" required control-label cf_brand_1213058-label " for="helpdesk_ticket_cf_brand_1213058">Brand</label>
            <div class="controls   ">
              <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_brand_1213058]" id="helpdesk_ticket_custom_field_cf_brand_1213058" />
            </div> 
                  </div>
                      <div class="control-group ticket_section">
                         <label class="  control-label cf_client_1213058-label " for="helpdesk_ticket_cf_client_1213058">Client</label>
            <div class="controls nested_field  ">
              <select class="  nested_field section_field" id="helpdesk_ticket_custom_field_cf_client_1213058_47000046700" name="helpdesk_ticket[custom_field][cf_client_1213058]"><option value="">...</option>
<option value="Verizon">Verizon</option></select><div class="level_2"><label class="">Product</label><select class="  nested_field section_field" id="helpdesk_ticket_custom_field_cf_product_1213058_47000046700" name="helpdesk_ticket[custom_field][cf_product_1213058]"><option value="">...</option>
</select></div><div class="level_3"><label class="">What's wrong? </label><select class="  nested_field section_field" id="helpdesk_ticket_custom_field_cf_issue_1213058_47000046700" name="helpdesk_ticket[custom_field][cf_issue_1213058]"><option value="">...</option>
</select></div><script>
//<![CDATA[
jQuery('#helpdesk_ticket_custom_field_cf_client_1213058_47000046700').nested_select_tag({"data_tree":[["Verizon","Verizon",[["Digital V","Digital V",[["Screen dark","Screen dark"],["Modules/sections out","Modules/sections out"],["Content not playing","Content not playing"],["Damage – structural","Damage – structural"],["Damage – cosmetic","Damage – cosmetic"],["Other","Other"]]],["Billboard - COB","Billboard - COB",[["Screen dark","Screen dark"],["Sections out","Sections out"],["Color/flicker","Color/flicker"],["Content not playing","Content not playing"],["Damage – structural","Damage – structural"],["Damage – cosmetic","Damage – cosmetic"],["Other","Other"]]],["Google AI Table","Google AI Table",[["Safety concern","Safety concern"],["Screen dark","Screen dark"],["Screen frozen / touch","Screen frozen / touch"],["Lights out","Lights out"],["Camera","Camera"],["Damage – structural","Damage – structural"],["Damage – cosmetic","Damage – cosmetic"],["Install problem","Install problem"],["Other","Other"]]]]]],"initValues":null,"disable_children":false,"include_blank":"...","selected":null,"pl_value_id":"47000046700","subcategory_id":"helpdesk_ticket_custom_field_cf_product_1213058_47000046700","item_id":"helpdesk_ticket_custom_field_cf_issue_1213058_47000046700"});
//]]>
</script>
            </div> 
                      </div>
                  <div class="control-group ticket_section">
                     <label class=" required control-label cf_store_name_1213058-label " for="helpdesk_ticket_cf_store_name_1213058">Store Name </label>
            <div class="controls   ">
              <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_store_name_1213058]" id="helpdesk_ticket_custom_field_cf_store_name_1213058" />
            </div> 
                  </div>
                  <div class="control-group ticket_section">
                     <label class=" required control-label cf_store_contact_1213058-label " for="helpdesk_ticket_cf_store_contact_1213058">Store Contact</label>
            <div class="controls   ">
              <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_store_contact_1213058]" id="helpdesk_ticket_custom_field_cf_store_contact_1213058" />
            </div> 
                  </div>
                  <div class="control-group ticket_section">
                     <label class=" required control-label cf_contact_number_1213058-label " for="helpdesk_ticket_cf_contact_number_1213058">Contact Phone</label>
            <div class="controls   ">
              <input class=" required number section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_contact_number_1213058]" id="helpdesk_ticket_custom_field_cf_contact_number_1213058" />
            </div> 
                  </div>
                  <div class="control-group ticket_section">
                     <label class=" required control-label cf_store_address_1213058-label " for="helpdesk_ticket_cf_store_address_1213058">Store Address</label>
            <div class="controls   ">
              <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_store_address_1213058]" id="helpdesk_ticket_custom_field_cf_store_address_1213058" />
            </div> 
                  </div>
                  <div class="control-group ticket_section">
                      <div class="controls">
            <label class="checkbox ">
              <input name="helpdesk_ticket[custom_field][cf_photo_has_been_added_1213058]" type="hidden" value="0" autocomplete="off" /><input class="  checkbox section_field" id="helpdesk_ticket_custom_field_cf_photo_has_been_added_1213058_47000046700" type="checkbox" value="1" name="helpdesk_ticket[custom_field][cf_photo_has_been_added_1213058]" /> Confirm at least one photo of image is uploaded
            </label>
          </div> 
                  </div>

<div class="control-group ticket_section">
                     <label class="  control-label cf_brand415612_1213058-label " for="helpdesk_ticket_cf_brand415612_1213058">Brand</label>
            <div class="controls   ">
              <input class="  text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_brand415612_1213058]" id="helpdesk_ticket_custom_field_cf_brand415612_1213058" />
            </div> 
                  </div>
                  <div class="control-group ticket_section">
                     <label class="  control-label cf_store_name278756_1213058-label " for="helpdesk_ticket_cf_store_name278756_1213058">Store Name</label>
            <div class="controls   ">
              <input class="  text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_store_name278756_1213058]" id="helpdesk_ticket_custom_field_cf_store_name278756_1213058" />
            </div> 
                  </div>
                  <div class="control-group ticket_section">
                     <label class="  control-label cf_store_address507993_1213058-label " for="helpdesk_ticket_cf_store_address507993_1213058">Store Address</label>
            <div class="controls   ">
              <input class="  text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_store_address507993_1213058]" id="helpdesk_ticket_custom_field_cf_store_address507993_1213058" />
            </div> 
                  </div>
                  <div class="control-group ticket_section">
                     <label class="  control-label cf_store_contact518783_1213058-label " for="helpdesk_ticket_cf_store_contact518783_1213058">Store Contact</label>
            <div class="controls   ">
              <input class="  text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_store_contact518783_1213058]" id="helpdesk_ticket_custom_field_cf_store_contact518783_1213058" />
            </div> 
                  </div>
                  <div class="control-group ticket_section">
                     <label class="  control-label cf_contact_number647101_1213058-label " for="helpdesk_ticket_cf_contact_number647101_1213058">Contact Number</label>
            <div class="controls   ">
              <input class="  number section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_contact_number647101_1213058]" id="helpdesk_ticket_custom_field_cf_contact_number647101_1213058" />
            </div> 
                  </div>
                  <div class="control-group ticket_section">
                      <div class="controls">
            <label class="checkbox ">
              <input name="helpdesk_ticket[custom_field][cf_photo_has_been_added683016_1213058]" type="hidden" value="0" autocomplete="off" /><input class="  checkbox section_field" id="helpdesk_ticket_custom_field_cf_photo_has_been_added683016_1213058_47001490375" type="checkbox" value="1" name="helpdesk_ticket[custom_field][cf_photo_has_been_added683016_1213058]" /> Photo has been added
            </label>
          </div> 
                  </div>

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