Midwich Group Plc Widget

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<div class="control-group ticket_section">
	              <div class="control-group">
	               <label class="  control-label technical_product_type_493124-label" data-field-label="technical_product_type_493124" for="helpdesk_ticket_technical_product_type_493124">Technical Product Type</label>
	   			<div class="controls ">
	   				<select class="  dropdown_blank section_field" data-field-name="technical_product_type_493124" name="helpdesk_ticket[custom_field][technical_product_type_493124]" id="helpdesk_ticket_custom_field_technical_product_type_493124"><option value="">...</option>
<option data-id="52000151112" data-display-id="1267" value="NEC">NEC</option>
<option data-id="52000151113" data-display-id="1268" value="Mitel">Mitel</option>
<option data-id="52000151114" data-display-id="1269" value="Yealink">Yealink</option>
<option data-id="52000151115" data-display-id="1270" value="Unify">Unify</option>
<option data-id="52000151116" data-display-id="1271" value="Simplified UC">Simplified UC</option>
<option data-id="52000151117" data-display-id="1272" value="Connectivity">Connectivity</option>
<option data-id="52000151118" data-display-id="1273" value="SIP">SIP</option>
<option data-id="52000151119" data-display-id="1274" value="Other">Other</option></select>
	   			</div> 
	              </div>
	              	              <div class="control-group">
	               <label class="  control-label issue_with_product_493124-label" data-field-label="issue_with_product_493124" for="helpdesk_ticket_issue_with_product_493124">Issue With Product</label>
	   			<div class="controls ">
	   				<select class="  dropdown_blank section_field" data-field-name="issue_with_product_493124" name="helpdesk_ticket[custom_field][issue_with_product_493124]" id="helpdesk_ticket_custom_field_issue_with_product_493124"><option value="">...</option>
<option data-id="52000151120" data-display-id="1275" value="Firmware">Firmware</option>
<option data-id="52000151121" data-display-id="1276" value="Platform">Platform</option>
<option data-id="52000151122" data-display-id="1277" value="End Point">End Point</option>
<option data-id="52000151123" data-display-id="1278" value="Other">Other</option></select>
	   			</div> 
	              </div>
	               </div>

<div class="control-group ticket_section">
	              <div class="control-group">
	               <label class="  control-label nimans_sales_person_name_493124-label" data-field-label="nimans_sales_person_name_493124" for="helpdesk_ticket_nimans_sales_person_name_493124">Nimans Sales Person Name</label>
	   			<div class="controls ">
	   				<input class="  text section_field span12" data-field-name="nimans_sales_person_name_493124" type="text" name="helpdesk_ticket[custom_field][nimans_sales_person_name_493124]" id="helpdesk_ticket_custom_field_nimans_sales_person_name_493124" />
	   			</div> 
	              </div>
	              	              <div class="control-group">
	               <label class="  control-label msf_sales_team_493124-label" data-field-label="msf_sales_team_493124" for="helpdesk_ticket_msf_sales_team_493124">Sales Team</label>
	   			<div class="controls ">
	   				<input name="helpdesk_ticket[custom_field][msf_sales_team_493124][]" type="hidden" value="" autocomplete="off" /><select class="  dropdown_blank section_field" multiple="multiple" data-field-name="msf_sales_team_493124" name="helpdesk_ticket[custom_field][msf_sales_team_493124][]" id="helpdesk_ticket_custom_field_msf_sales_team_493124"><option data-id="1206" value="1206">Channel Sales</option>
<option data-id="1207" value="1207">Catagory Team</option>
<option data-id="1208" value="1208">New Business</option>
<option data-id="1209" value="1209">Other</option></select>
	   			</div> 
	              </div>
	              	              <div class="control-group">
	               <label class="  control-label partner_company_name_493124-label" data-field-label="partner_company_name_493124" for="helpdesk_ticket_partner_company_name_493124">Partner Name</label>
	   			<div class="controls ">
	   				<input class="  text section_field span12" data-field-name="partner_company_name_493124" type="text" name="helpdesk_ticket[custom_field][partner_company_name_493124]" id="helpdesk_ticket_custom_field_partner_company_name_493124" />
	   			</div> 
	              </div>
	              	              <div class="control-group">
	               <label class="  control-label partner_contact_name_493124-label" data-field-label="partner_contact_name_493124" for="helpdesk_ticket_partner_contact_name_493124">Partner Contact Name</label>
	   			<div class="controls ">
	   				<input class="  text section_field span12" data-field-name="partner_contact_name_493124" type="text" name="helpdesk_ticket[custom_field][partner_contact_name_493124]" id="helpdesk_ticket_custom_field_partner_contact_name_493124" />
	   			</div> 
	              </div>
	              	              <div class="control-group">
	               <label class="  control-label partner_contact_number_493124-label" data-field-label="partner_contact_number_493124" for="helpdesk_ticket_partner_contact_number_493124">Partner Contact Number</label>
	   			<div class="controls ">
	   				<input class="  text section_field span12" data-field-name="partner_contact_number_493124" type="text" name="helpdesk_ticket[custom_field][partner_contact_number_493124]" id="helpdesk_ticket_custom_field_partner_contact_number_493124" />
	   			</div> 
	              </div>
	              	              <div class="control-group">
	               <label class="  control-label partner_email_address_493124-label" data-field-label="partner_email_address_493124" for="helpdesk_ticket_partner_email_address_493124">Partner Email Address</label>
	   			<div class="controls ">
	   				<input class="  text section_field span12" data-field-name="partner_email_address_493124" type="text" name="helpdesk_ticket[custom_field][partner_email_address_493124]" id="helpdesk_ticket_custom_field_partner_email_address_493124" />
	   			</div> 
	              </div>
	              	              <div class="control-group">
	               <label class="  control-label partner_website_url_493124-label" data-field-label="partner_website_url_493124" for="helpdesk_ticket_partner_website_url_493124">Partner Website URL</label>
	   			<div class="controls ">
	   				<input class="  text section_field span12" data-field-name="partner_website_url_493124" type="text" name="helpdesk_ticket[custom_field][partner_website_url_493124]" id="helpdesk_ticket_custom_field_partner_website_url_493124" />
	   			</div> 
	              </div>
	              	              <div class="control-group">
	               <label class="  control-label partner_masterpack_number_493124-label" data-field-label="partner_masterpack_number_493124" for="helpdesk_ticket_partner_masterpack_number_493124">Partner Masterpack Number</label>
	   			<div class="controls ">
	   				<input class="  text section_field span12" data-field-name="partner_masterpack_number_493124" type="text" name="helpdesk_ticket[custom_field][partner_masterpack_number_493124]" id="helpdesk_ticket_custom_field_partner_masterpack_number_493124" />
	   			</div> 
	              </div>
	              	              <div class="control-group">
	               <label class="  control-label msf_account_source_493124-label" data-field-label="msf_account_source_493124" for="helpdesk_ticket_msf_account_source_493124">Source</label>
	   			<div class="controls ">
	   				<input name="helpdesk_ticket[custom_field][msf_account_source_493124][]" type="hidden" value="" autocomplete="off" /><select class="  dropdown_blank section_field" multiple="multiple" data-field-name="msf_account_source_493124" name="helpdesk_ticket[custom_field][msf_account_source_493124][]" id="helpdesk_ticket_custom_field_msf_account_source_493124"><option data-id="1210" value="1210">Nimans Connect</option>
<option data-id="1211" value="1211">Channel</option></select>
	   			</div> 
	              </div>
	              	              <div class="control-group">
	               <label class="  control-label msf_enquiry_type_493124-label" data-field-label="msf_enquiry_type_493124" for="helpdesk_ticket_msf_enquiry_type_493124">Enquiry Type </label>
	   			<div class="controls ">
	   				<input name="helpdesk_ticket[custom_field][msf_enquiry_type_493124][]" type="hidden" value="" autocomplete="off" /><select class="  dropdown_blank section_field" multiple="multiple" data-field-name="msf_enquiry_type_493124" name="helpdesk_ticket[custom_field][msf_enquiry_type_493124][]" id="helpdesk_ticket_custom_field_msf_enquiry_type_493124"><option data-id="1212" value="1212">Mobile</option>
<option data-id="1213" value="1213">Connectivity (Data/Broadband)</option>
<option data-id="1214" value="1214">Hosted</option>
<option data-id="1215" value="1215">Billing</option>
<option data-id="1216" value="1216">Other</option></select>
	   			</div> 
	              </div>
	               </div>

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