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<div class="control-group ticket_section"> <label class=" control-label cf_order_date69455_1389321-label " for="helpdesk_ticket_cf_order_date69455_1389321">Order date</label> <div class="controls support-date-field "> <input type="text" name="helpdesk_ticket[custom_field][cf_order_date69455_1389321]" id="helpdesk_ticket_custom_field_cf_order_date69455_1389321" class=" 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=" control-label cf_order_number_1389321-label " for="helpdesk_ticket_cf_order_number_1389321">Order number</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_order_number_1389321]" id="helpdesk_ticket_custom_field_cf_order_number_1389321" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_reason_for_return_1389321-label " for="helpdesk_ticket_cf_reason_for_return_1389321">Reason for return</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_reason_for_return_1389321]" id="helpdesk_ticket_custom_field_cf_reason_for_return_1389321" /> </div> </div> <div class="control-group ticket_section"> <div class="controls"> <label class="checkbox "> <input name="helpdesk_ticket[custom_field][cf_disclaimer_1389321]" type="hidden" value="0" /><input class=" checkbox section_field" id="helpdesk_ticket_custom_field_cf_disclaimer_1389321_77000721359" type="checkbox" value="1" name="helpdesk_ticket[custom_field][cf_disclaimer_1389321]" /> I confirm my watch is unworn </label> </div> </div>
<div class="control-group ticket_section"> <label class=" control-label cf_purchase_date_1389321-label " for="helpdesk_ticket_cf_purchase_date_1389321">Purchase date</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_purchase_date_1389321]" id="helpdesk_ticket_custom_field_cf_purchase_date_1389321" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_where_was_it_purchased_1389321-label " for="helpdesk_ticket_cf_where_was_it_purchased_1389321">Where was it purchased?</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_where_was_it_purchased_1389321]" id="helpdesk_ticket_custom_field_cf_where_was_it_purchased_1389321" /> </div> </div>
<div class="control-group ticket_section"> <label class=" control-label cf_order_number805562_1389321-label " for="helpdesk_ticket_cf_order_number805562_1389321">Order number</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_order_number805562_1389321]" id="helpdesk_ticket_custom_field_cf_order_number805562_1389321" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_tracking_number857708_1389321-label " for="helpdesk_ticket_cf_tracking_number857708_1389321">Tracking number</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_tracking_number857708_1389321]" id="helpdesk_ticket_custom_field_cf_tracking_number857708_1389321" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_order_date_1389321-label " for="helpdesk_ticket_cf_order_date_1389321">Order date</label> <div class="controls support-date-field "> <input type="text" name="helpdesk_ticket[custom_field][cf_order_date_1389321]" id="helpdesk_ticket_custom_field_cf_order_date_1389321" class=" date section_field datepicker_popover" readonly="readonly" data-show-image="true" data-date-format="d M, yy" placeholder="" /> </div> </div>
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