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<label class=" control-label cf_error_messagename_897004-label " for="helpdesk_ticket_cf_error_messagename_897004">Error Message/Code</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_error_messagename_897004]" id="helpdesk_ticket_custom_field_cf_error_messagename_897004" /> </div>
<label class=" control-label cf_date_participated_897004-label " for="helpdesk_ticket_cf_date_participated_897004">Date</label> <div class="controls support-date-field "> <input type="text" name="helpdesk_ticket[custom_field][cf_date_participated_897004]" id="helpdesk_ticket_custom_field_cf_date_participated_897004" class=" date section_field datepicker_popover" readonly="readonly" data-show-image="true" data-date-format="M d, yy" placeholder="" /> </div>
<label class=" control-label cf_time_amp_time_zone_897004-label " for="helpdesk_ticket_cf_time_amp_time_zone_897004">Time and Time Zone</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_time_amp_time_zone_897004]" id="helpdesk_ticket_custom_field_cf_time_amp_time_zone_897004" /> </div>
<label class=" control-label cf_connection_type_897004-label " for="helpdesk_ticket_cf_connection_type_897004">What type of connection are you using?</label> <div class="controls "> <select class=" dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_connection_type_897004]" id="helpdesk_ticket_custom_field_cf_connection_type_897004"><option value="">...</option> <option data-id="43000420884" value="Mobile Data">Mobile Data</option> <option data-id="43000420885" value="Wi-fi">Wi-fi</option></select> </div>
<label class=" control-label cf_event_name_897004-label " for="helpdesk_ticket_cf_event_name_897004">Event Name</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_event_name_897004]" id="helpdesk_ticket_custom_field_cf_event_name_897004" /> </div>
<label class=" control-label cf_if_rewards_is_not_received_please_specify_897004-label " for="helpdesk_ticket_cf_if_rewards_is_not_received_please_specify_897004">If reward(s) is not received, please specify:</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_if_rewards_is_not_received_please_specify_897004]" id="helpdesk_ticket_custom_field_cf_if_rewards_is_not_received_please_specify_897004" /> </div>
<label class=" control-label cf_date_participated_897004-label " for="helpdesk_ticket_cf_date_participated_897004">Date</label> <div class="controls support-date-field "> <input type="text" name="helpdesk_ticket[custom_field][cf_date_participated_897004]" id="helpdesk_ticket_custom_field_cf_date_participated_897004" class=" date section_field datepicker_popover" readonly="readonly" data-show-image="true" data-date-format="M d, yy" placeholder="" /> </div>
<label class=" control-label cf_time_amp_time_zone_897004-label " for="helpdesk_ticket_cf_time_amp_time_zone_897004">Time and Time Zone</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_time_amp_time_zone_897004]" id="helpdesk_ticket_custom_field_cf_time_amp_time_zone_897004" /> </div>
<label class=" control-label cf_item_name_897004-label " for="helpdesk_ticket_cf_item_name_897004">Item Name</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_item_name_897004]" id="helpdesk_ticket_custom_field_cf_item_name_897004" /> </div>
<label class=" control-label cf_date_897004-label " for="helpdesk_ticket_cf_date_897004">Date</label> <div class="controls support-date-field "> <input type="text" name="helpdesk_ticket[custom_field][cf_date_897004]" id="helpdesk_ticket_custom_field_cf_date_897004" class=" date section_field datepicker_popover" readonly="readonly" data-show-image="true" data-date-format="M d, yy" placeholder="" /> </div>
<label class=" control-label cf_time_amp_time_zone_897004-label " for="helpdesk_ticket_cf_time_amp_time_zone_897004">Time and Time Zone</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_time_amp_time_zone_897004]" id="helpdesk_ticket_custom_field_cf_time_amp_time_zone_897004" /> </div>
<label class=" control-label cf_linked_to_897004-label " for="helpdesk_ticket_cf_linked_to_897004">Linked to:</label> <div class="controls "> <select class=" dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_linked_to_897004]" id="helpdesk_ticket_custom_field_cf_linked_to_897004"><option value="">...</option> <option data-id="43000266078" value="Facebook Account">Facebook Account</option> <option data-id="43000914583" value="Game Center">Game Center</option> <option data-id="43000266079" value="Google Account">Google Account</option> <option data-id="43000266080" value="Guest Login">Guest Login</option></select> </div>
<label class=" control-label cf_item_purchased_897004-label " for="helpdesk_ticket_cf_item_purchased_897004">Item Name</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_item_purchased_897004]" id="helpdesk_ticket_custom_field_cf_item_purchased_897004" /> </div>
<label class=" control-label cf_date_of_purchase_897004-label " for="helpdesk_ticket_cf_date_of_purchase_897004">Date of Purchase</label> <div class="controls support-date-field "> <input type="text" name="helpdesk_ticket[custom_field][cf_date_of_purchase_897004]" id="helpdesk_ticket_custom_field_cf_date_of_purchase_897004" class=" date section_field datepicker_popover" readonly="readonly" data-show-image="true" data-date-format="M d, yy" placeholder="" /> </div>
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