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<label class=" required control-label issue_596325-label " for="helpdesk_ticket_issue_596325">Inquiry</label> <div class="controls "> <select class=" required dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][issue_596325]" id="helpdesk_ticket_custom_field_issue_596325"><option value="">...</option> <option data-id="28000036528" value="Cancel Membership">Cancel Membership</option> <option data-id="28000036526" value="Question about charges on my bill">Question about charges on my bill</option> <option data-id="28000036527" value="Problem with Password">Problem with Password</option> <option data-id="28000036529" value="Other">Other</option></select> </div>
<label class=" required control-label website_596325-label " for="helpdesk_ticket_website_596325">Website Name/URL</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][website_596325]" id="helpdesk_ticket_custom_field_website_596325" /> </div>
<label class=" control-label username_596325-label " for="helpdesk_ticket_username_596325">Username</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][username_596325]" id="helpdesk_ticket_custom_field_username_596325" /> </div>
<label class=" control-label customer_id_596325-label " for="helpdesk_ticket_customer_id_596325">Invoice ID</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][customer_id_596325]" id="helpdesk_ticket_custom_field_customer_id_596325" /> </div>
<label class=" required control-label issue_596325-label " for="helpdesk_ticket_issue_596325">Inquiry</label> <div class="controls "> <select class=" required dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][issue_596325]" id="helpdesk_ticket_custom_field_issue_596325"><option value="">...</option> <option data-id="28000036528" value="Cancel Membership">Cancel Membership</option> <option data-id="28000036526" value="Question about charges on my bill">Question about charges on my bill</option> <option data-id="28000036527" value="Problem with Password">Problem with Password</option> <option data-id="28000036529" value="Other">Other</option></select> </div>
<label class=" required control-label website_596325-label " for="helpdesk_ticket_website_596325">Website Name/URL</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][website_596325]" id="helpdesk_ticket_custom_field_website_596325" /> </div>
<label class=" control-label username_596325-label " for="helpdesk_ticket_username_596325">Username</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][username_596325]" id="helpdesk_ticket_custom_field_username_596325" /> </div>
<label class=" control-label customer_id_596325-label " for="helpdesk_ticket_customer_id_596325">Invoice ID</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][customer_id_596325]" id="helpdesk_ticket_custom_field_customer_id_596325" /> </div>
<label class=" required control-label merchant_name_596325-label " for="helpdesk_ticket_merchant_name_596325">Merchant Name</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][merchant_name_596325]" id="helpdesk_ticket_custom_field_merchant_name_596325" /> </div>
<label class=" required control-label website_596325-label " for="helpdesk_ticket_website_596325">Website Name/URL</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][website_596325]" id="helpdesk_ticket_custom_field_website_596325" /> </div>
<label class=" control-label merchant_priorty_596325-label " for="helpdesk_ticket_merchant_priorty_596325">Merchant Priorty</label> <div class="controls "> <select class=" dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][merchant_priorty_596325]" id="helpdesk_ticket_custom_field_merchant_priorty_596325"><option value="">...</option> <option data-id="28000036651" value="Low">Low</option> <option data-id="28000072090" value="Medium">Medium</option> <option data-id="28000036652" value="High">High</option></select> </div>
<label class=" control-label reason_for_contact_596325-label " for="helpdesk_ticket_reason_for_contact_596325">Reason for contact</label> <div class="controls "> <select class=" dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][reason_for_contact_596325]" id="helpdesk_ticket_custom_field_reason_for_contact_596325"><option value="">...</option> <option data-id="28000036530" value="Integration Question">Integration Question</option> <option data-id="28000036531" value="Report Question">Report Question</option> <option data-id="28000036642" value="Accounting Question">Accounting Question</option> <option data-id="28000036645" value="Add Merchant Account (MID)">Add Merchant Account (MID)</option> <option data-id="28000036646" value="Risk Management">Risk Management</option></select> </div>
<label class=" control-label phone_596325-label " for="helpdesk_ticket_phone_596325">Phone (Optional)</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][phone_596325]" id="helpdesk_ticket_custom_field_phone_596325" /> </div>
<label class=" control-label cf_company_name_596325-label " for="helpdesk_ticket_cf_company_name_596325">Company Name</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_company_name_596325]" id="helpdesk_ticket_custom_field_cf_company_name_596325" /> </div>
<label class=" required control-label website_596325-label " for="helpdesk_ticket_website_596325">Website Name/URL</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][website_596325]" id="helpdesk_ticket_custom_field_website_596325" /> </div>
<label class=" control-label cf_do_you_have_a_merchant_accounts_596325-label " for="helpdesk_ticket_cf_do_you_have_a_merchant_accounts_596325">Do you have a merchant account(s)?</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_do_you_have_a_merchant_accounts_596325]" id="helpdesk_ticket_custom_field_cf_do_you_have_a_merchant_accounts_596325" /> </div>
<label class=" control-label monthly_processing_amount_596325-label " for="helpdesk_ticket_monthly_processing_amount_596325">Current Processing $ Amount Monthly</label> <div class="controls "> <input class=" number section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][monthly_processing_amount_596325]" id="helpdesk_ticket_custom_field_monthly_processing_amount_596325" /> </div>
<label class=" control-label cf_number_of_transactions_per_month_596325-label " for="helpdesk_ticket_cf_number_of_transactions_per_month_596325">Current Number of transactions per month</label> <div class="controls "> <input class=" number section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_number_of_transactions_per_month_596325]" id="helpdesk_ticket_custom_field_cf_number_of_transactions_per_month_596325" /> </div>
<label class=" control-label cf_company_location_596325-label " for="helpdesk_ticket_cf_company_location_596325">Company Location</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_company_location_596325]" id="helpdesk_ticket_custom_field_cf_company_location_596325" /> </div>
<label class=" required control-label cf_phone_number_596325-label " for="helpdesk_ticket_cf_phone_number_596325">Phone Number</label> <div class="controls "> <input class=" required number section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_phone_number_596325]" id="helpdesk_ticket_custom_field_cf_phone_number_596325" /> </div>
<label class=" required control-label cf_how_did_you_hear_about_rocketgate_596325-label " for="helpdesk_ticket_cf_how_did_you_hear_about_rocketgate_596325">How did you hear about RocketGate?</label> <div class="controls "> <select class=" required dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_how_did_you_hear_about_rocketgate_596325]" id="helpdesk_ticket_custom_field_cf_how_did_you_hear_about_rocketgate_596325"><option value="">...</option> <option data-id="28000069465" value="Referral">Referral</option> <option data-id="28000069466" value="Tradeshow/Conference">Tradeshow/Conference</option> <option data-id="28000069467" value="Internet Search">Internet Search</option> <option data-id="28000069468" value="Other">Other</option></select> </div>
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