<div class="control-group ticket_section"> <label class=" required control-label cf_currency_1092050-label " for="helpdesk_ticket_cf_currency_1092050">Currency</label> <div class="controls "> <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_currency_1092050" name="helpdesk_ticket[custom_field][cf_currency_1092050]"><option value="">...</option> <option value="USD" data-id="2043001574289">USD</option> <option value="GBP" data-id="2043001574290">GBP</option> <option value="Euros" data-id="2043001574291">Euros</option> <option value="JPY" data-id="2043001574292">JPY</option> <option value="CAD" data-id="2043002493855">CAD</option> <option value="AUSD" data-id="2043002493856">AUSD</option> <option value="BRL" data-id="2043002493857">BRL</option> <option value="WONG" data-id="2043002493858">WONG</option> <option value="INR" data-id="2043002493859">INR</option></select> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_new_team_subscription_size_1092050-label " for="helpdesk_ticket_cf_new_team_subscription_size_1092050">Team Subscription Size</label> <div class="controls "> <input class=" number section_field span12" id="helpdesk_ticket_custom_field_cf_new_team_subscription_size_1092050" name="helpdesk_ticket[custom_field][cf_new_team_subscription_size_1092050]" size="30" type="text" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_vat_number_1092050-label " for="helpdesk_ticket_cf_vat_number_1092050">VAT Number ( If applicable) </label> <div class="controls "> <input class=" text section_field span12" id="helpdesk_ticket_custom_field_cf_vat_number_1092050" name="helpdesk_ticket[custom_field][cf_vat_number_1092050]" size="30" type="text" /> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_preferred_payment_method_1092050-label " for="helpdesk_ticket_cf_preferred_payment_method_1092050">Preferred Payment Method</label> <div class="controls "> <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_preferred_payment_method_1092050" name="helpdesk_ticket[custom_field][cf_preferred_payment_method_1092050]"><option value="">...</option> <option value="Purchase on Website" data-id="2043001574491">Purchase on Website</option> <option value="Bank Transfer" data-id="2043001574492">Bank Transfer</option> <option value="PayPal" data-id="2043001574493">PayPal</option> <option value="Credit Card link" data-id="2043001574494">Credit Card link</option></select> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_company_billing_address_1092050-label " for="helpdesk_ticket_cf_company_billing_address_1092050">Company Billing Address</label> <div class="controls "> <textarea class=" paragraph section_field span12" cols="40" id="helpdesk_ticket_custom_field_cf_company_billing_address_1092050" name="helpdesk_ticket[custom_field][cf_company_billing_address_1092050]" rows="6"> </textarea> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_team_size_1092050-label " for="helpdesk_ticket_cf_team_size_1092050">Team Size</label> <div class="controls "> <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_team_size_1092050" name="helpdesk_ticket[custom_field][cf_team_size_1092050]"><option value="">...</option> <option value="5" data-id="2043001498837">5</option> <option value="10" data-id="2043001498838">10</option> <option value="20" data-id="2043001498839">20</option> <option value="40" data-id="2043001498840">40</option> <option value="60" data-id="2043001498841">60</option> <option value="100" data-id="2043001498842">100</option> <option value="over 100" data-id="2043001498843">over 100</option></select> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_industry_area_1092050-label " for="helpdesk_ticket_cf_industry_area_1092050">Industry Area</label> <div class="controls "> <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_industry_area_1092050" name="helpdesk_ticket[custom_field][cf_industry_area_1092050]"><option value="">...</option> <option value="ARCHITECTURE" data-id="2043001498823">ARCHITECTURE</option> <option value="AUTOMOTIVE" data-id="2043001498824">AUTOMOTIVE</option> <option value="BANKING" data-id="2043001498825">BANKING</option> <option value="COMPUTERS_AND_IT" data-id="2043001498826">COMPUTERS_AND_IT</option> <option value="CONSTRUCTION" data-id="2043001498827">CONSTRUCTION</option> <option value="FINANCE" data-id="2043001873474">FINANCE</option> <option value="ACCOUNTANCY" data-id="2043001873475">ACCOUNTANCY</option> <option value="HUMAN_RESOURCES" data-id="2043001873476">HUMAN_RESOURCES</option> <option value="GOVERNMENT" data-id="2043001498828">GOVERNMENT</option> <option value="HEALTH" data-id="2043001498829">HEALTH</option> <option value="LEGAL" data-id="2043001498830">LEGAL</option> <option value="RETAIL" data-id="2043001498831">RETAIL</option> <option value="NEURODIVERISTY- DSA or ATW" data-id="2043002483039">NEURODIVERISTY- DSA or ATW</option> <option value="MANUFACTURING" data-id="2043001498832">MANUFACTURING</option> <option value="MARKETING" data-id="2043001498833">MARKETING</option> <option value="MEDIA" data-id="2043001498834">MEDIA</option> <option value="NON_PROFIT" data-id="2043001498835">NON_PROFIT</option> <option value="TRANSPORT" data-id="2043001498836">TRANSPORT</option> <option value="OTHER" data-id="2043001560720">OTHER</option></select> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_company_name_1092050-label " for="helpdesk_ticket_cf_company_name_1092050">Company Name</label> <div class="controls "> <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_company_name_1092050" name="helpdesk_ticket[custom_field][cf_company_name_1092050]" size="30" type="text" /> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_time_zone_1092050-label " for="helpdesk_ticket_cf_time_zone_1092050">Time Zone</label> <div class="controls "> <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_time_zone_1092050" name="helpdesk_ticket[custom_field][cf_time_zone_1092050]" size="30" type="text" /> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_demo_time_1092050-label " for="helpdesk_ticket_cf_demo_time_1092050">Demo Time</label> <div class="controls "> <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_demo_time_1092050" name="helpdesk_ticket[custom_field][cf_demo_time_1092050]"><option value="">...</option> <option value="Morning" data-id="2043001498844">Morning</option> <option value="Afternoon" data-id="2043001498845">Afternoon</option></select> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_demo_date_1092050-label " for="helpdesk_ticket_cf_demo_date_1092050">Demo Date</label> <div class="controls support-date-field "> <input class=" required date section_field datepicker_popover" data-date-format="d M, yy" data-show-image="true" id="helpdesk_ticket_custom_field_cf_demo_date_1092050" name="helpdesk_ticket[custom_field][cf_demo_date_1092050]" readonly="readonly" type="text" /> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_demo_time_available_1092050-label " for="helpdesk_ticket_cf_demo_time_available_1092050">Demo Time Available</label> <div class="controls "> <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_demo_time_available_1092050" name="helpdesk_ticket[custom_field][cf_demo_time_available_1092050]"><option value="">...</option> <option value="30 minutes" data-id="2043001498846">30 minutes</option> <option value="45 minutes" data-id="2043001498847">45 minutes</option> <option value="1 hour" data-id="2043001498848">1 hour</option></select> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_phone_number_1092050-label " for="helpdesk_ticket_cf_phone_number_1092050">Phone Number International Format</label> <div class="controls "> <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_phone_number_1092050" name="helpdesk_ticket[custom_field][cf_phone_number_1092050]" size="30" type="text" /> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_territory_that_you_wish_to_distribute_within_1092050-label " for="helpdesk_ticket_cf_territory_that_you_wish_to_distribute_within_1092050">Territory that you wish to distribute within</label> <div class="controls "> <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_territory_that_you_wish_to_distribute_within_1092050" name="helpdesk_ticket[custom_field][cf_territory_that_you_wish_to_distribute_within_1092050]" size="30" type="text" /> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_currency_you_would_like_your_orders_to_be_processed_1092050-label " for="helpdesk_ticket_cf_currency_you_would_like_your_orders_to_be_processed_1092050">Currency you would like your orders to be processed </label> <div class="controls "> <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_currency_you_would_like_your_orders_to_be_processed_1092050" name="helpdesk_ticket[custom_field][cf_currency_you_would_like_your_orders_to_be_processed_1092050]"><option value="">...</option> <option value="USD" data-id="2043001574645">USD</option> <option value="GBP" data-id="2043001574646">GBP</option> <option value="Euros" data-id="2043001574647">Euros</option> <option value="JPY Yen" data-id="2043001574648">JPY Yen</option></select> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_vat_registration_number_1092050-label " for="helpdesk_ticket_cf_vat_registration_number_1092050">VAT Registration Number ( If applicable) </label> <div class="controls "> <input class=" text section_field span12" id="helpdesk_ticket_custom_field_cf_vat_registration_number_1092050" name="helpdesk_ticket[custom_field][cf_vat_registration_number_1092050]" size="30" type="text" /> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_company_registered_address_1092050-label " for="helpdesk_ticket_cf_company_registered_address_1092050">Company Registered Address</label> <div class="controls "> <textarea class=" required paragraph section_field span12" cols="40" id="helpdesk_ticket_custom_field_cf_company_registered_address_1092050" name="helpdesk_ticket[custom_field][cf_company_registered_address_1092050]" rows="6"> </textarea> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_company_website_1092050-label " for="helpdesk_ticket_cf_company_website_1092050">Company Website (If applicable) </label> <div class="controls "> <input class=" text section_field span12" id="helpdesk_ticket_custom_field_cf_company_website_1092050" name="helpdesk_ticket[custom_field][cf_company_website_1092050]" size="30" type="text" /> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_minimum_order_1092050-label " for="helpdesk_ticket_cf_minimum_order_1092050">First minimum order- total value after discount £500 ( before VAT)</label> <div class="controls "> <textarea class=" required paragraph section_field span12" cols="40" id="helpdesk_ticket_custom_field_cf_minimum_order_1092050" name="helpdesk_ticket[custom_field][cf_minimum_order_1092050]" rows="6"> </textarea> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_name_1092050-label " for="helpdesk_ticket_cf_name_1092050">Name</label> <div class="controls "> <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_name_1092050" name="helpdesk_ticket[custom_field][cf_name_1092050]" size="30" type="text" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_social_media_1092050-label " for="helpdesk_ticket_cf_social_media_1092050">Please provide a link to your main business social media page</label> <div class="controls "> <input class=" text section_field span12" id="helpdesk_ticket_custom_field_cf_social_media_1092050" name="helpdesk_ticket[custom_field][cf_social_media_1092050]" size="30" type="text" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_website_link_1092050-label " for="helpdesk_ticket_cf_website_link_1092050">If applicable, please provide a link to your website</label> <div class="controls "> <input class=" text section_field span12" id="helpdesk_ticket_custom_field_cf_website_link_1092050" name="helpdesk_ticket[custom_field][cf_website_link_1092050]" size="30" type="text" /> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_why_do_you_want_to_be_an_affiliate_1092050-label " for="helpdesk_ticket_cf_why_do_you_want_to_be_an_affiliate_1092050">Please tell us more about why you wish to become an affiliate</label> <div class="controls "> <textarea class=" required paragraph section_field span12" cols="40" id="helpdesk_ticket_custom_field_cf_why_do_you_want_to_be_an_affiliate_1092050" name="helpdesk_ticket[custom_field][cf_why_do_you_want_to_be_an_affiliate_1092050]" rows="6"> </textarea> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_are_you_the_account_holder_1092050-label " for="helpdesk_ticket_cf_are_you_the_account_holder_1092050">Are you the account holder?</label> <div class="controls "> <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_are_you_the_account_holder_1092050" name="helpdesk_ticket[custom_field][cf_are_you_the_account_holder_1092050]"><option value="">...</option> <option value="Yes" data-id="2043001574867">Yes</option> <option value="No" data-id="2043001574868">No</option></select> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_what_is_the_email_address_of_the_account_holder_1092050-label " for="helpdesk_ticket_cf_what_is_the_email_address_of_the_account_holder_1092050">What is the email address of the account holder?</label> <div class="controls "> <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_what_is_the_email_address_of_the_account_holder_1092050" name="helpdesk_ticket[custom_field][cf_what_is_the_email_address_of_the_account_holder_1092050]" size="30" type="text" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_name_of_account_holder_1092050-label " for="helpdesk_ticket_cf_name_of_account_holder_1092050">Name of Account Holder</label> <div class="controls "> <input class=" text section_field span12" id="helpdesk_ticket_custom_field_cf_name_of_account_holder_1092050" name="helpdesk_ticket[custom_field][cf_name_of_account_holder_1092050]" size="30" type="text" /> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_billing_address_of_account_holder_1092050-label " for="helpdesk_ticket_cf_billing_address_of_account_holder_1092050">Billing Address of Account Holder </label> <div class="controls "> <textarea class=" required paragraph section_field span12" cols="40" id="helpdesk_ticket_custom_field_cf_billing_address_of_account_holder_1092050" name="helpdesk_ticket[custom_field][cf_billing_address_of_account_holder_1092050]" rows="6"> </textarea> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_briefly_describe_the_issue_1092050-label " for="helpdesk_ticket_cf_briefly_describe_the_issue_1092050">What issue are you experiencing?</label> <div class="controls "> <textarea class=" required paragraph section_field span12" cols="40" id="helpdesk_ticket_custom_field_cf_briefly_describe_the_issue_1092050" name="helpdesk_ticket[custom_field][cf_briefly_describe_the_issue_1092050]" rows="6"> </textarea> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_steps_to_reproduce_1092050-label " for="helpdesk_ticket_cf_steps_to_reproduce_1092050">If applicable, could you outline the step by step actions taken before the issue occurs.</label> <div class="controls "> <textarea class=" paragraph section_field span12" cols="40" id="helpdesk_ticket_custom_field_cf_steps_to_reproduce_1092050" name="helpdesk_ticket[custom_field][cf_steps_to_reproduce_1092050]" rows="6"> </textarea> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_device_and_operating_system_1092050-label " for="helpdesk_ticket_cf_device_and_operating_system_1092050">Device and Operating System e.g Macbook Mojave 10.14.3 </label> <div class="controls "> <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_device_and_operating_system_1092050" name="helpdesk_ticket[custom_field][cf_device_and_operating_system_1092050]" size="30" type="text" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_web_browser_1092050-label " for="helpdesk_ticket_cf_web_browser_1092050">If using the Web-app, what web-browser are you using? e.g Firefox, Chrome</label> <div class="controls "> <input class=" text section_field span12" id="helpdesk_ticket_custom_field_cf_web_browser_1092050" name="helpdesk_ticket[custom_field][cf_web_browser_1092050]" size="30" type="text" /> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_briefly_describe_the_issue_1092050-label " for="helpdesk_ticket_cf_briefly_describe_the_issue_1092050">What issue are you experiencing?</label> <div class="controls "> <textarea class=" required paragraph section_field span12" cols="40" id="helpdesk_ticket_custom_field_cf_briefly_describe_the_issue_1092050" name="helpdesk_ticket[custom_field][cf_briefly_describe_the_issue_1092050]" rows="6"> </textarea> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_steps_to_reproduce_1092050-label " for="helpdesk_ticket_cf_steps_to_reproduce_1092050">If applicable, could you outline the step by step actions taken before the issue occurs.</label> <div class="controls "> <textarea class=" paragraph section_field span12" cols="40" id="helpdesk_ticket_custom_field_cf_steps_to_reproduce_1092050" name="helpdesk_ticket[custom_field][cf_steps_to_reproduce_1092050]" rows="6"> </textarea> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_device_and_operating_system_1092050-label " for="helpdesk_ticket_cf_device_and_operating_system_1092050">Device and Operating System e.g Macbook Mojave 10.14.3 </label> <div class="controls "> <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_device_and_operating_system_1092050" name="helpdesk_ticket[custom_field][cf_device_and_operating_system_1092050]" size="30" type="text" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_web_browser_1092050-label " for="helpdesk_ticket_cf_web_browser_1092050">If using the Web-app, what web-browser are you using? e.g Firefox, Chrome</label> <div class="controls "> <input class=" text section_field span12" id="helpdesk_ticket_custom_field_cf_web_browser_1092050" name="helpdesk_ticket[custom_field][cf_web_browser_1092050]" size="30" type="text" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_the_territory_you_would_like_to_represent_1092050-label " for="helpdesk_ticket_cf_the_territory_you_would_like_to_represent_1092050">The territory you would like to represent?</label> <div class="controls "> <input class=" text section_field span12" id="helpdesk_ticket_custom_field_cf_the_territory_you_would_like_to_represent_1092050" name="helpdesk_ticket[custom_field][cf_the_territory_you_would_like_to_represent_1092050]" size="30" type="text" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_company_website840188_1092050-label " for="helpdesk_ticket_cf_company_website840188_1092050">Company website</label> <div class="controls "> <input class=" text section_field span12" id="helpdesk_ticket_custom_field_cf_company_website840188_1092050" name="helpdesk_ticket[custom_field][cf_company_website840188_1092050]" size="30" type="text" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_why_would_you_be_a_suitable_global_partner_1092050-label " for="helpdesk_ticket_cf_why_would_you_be_a_suitable_global_partner_1092050">Why would you be a suitable Global Partner?</label> <div class="controls "> <textarea class=" paragraph section_field span12" cols="40" id="helpdesk_ticket_custom_field_cf_why_would_you_be_a_suitable_global_partner_1092050" name="helpdesk_ticket[custom_field][cf_why_would_you_be_a_suitable_global_partner_1092050]" rows="6"> </textarea> </div> </div>