Submit a ticket :

Submit a ticket

Email Address

Subject

What can we help you with today?

<div class="control-group ticket_section">
                   <label class=" required control-label cf_where_are_you_located_767774-label " for="helpdesk_ticket_cf_where_are_you_located_767774">Where are you located?</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_where_are_you_located_767774" name="helpdesk_ticket[custom_field][cf_where_are_you_located_767774]"><option value="">...</option>
<option value="North, Central or South America" data-id="7000155134">North, Central or South America</option>
<option value="Europe, Africa, Asia or Oceania" data-id="7000155135">Europe, Africa, Asia or Oceania</option></select>
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_customer_city_au_767774-label " for="helpdesk_ticket_cf_customer_city_au_767774">Your City</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_customer_city_au_767774" name="helpdesk_ticket[custom_field][cf_customer_city_au_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_customer_country_au_767774-label " for="helpdesk_ticket_cf_customer_country_au_767774">Your Country</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_customer_country_au_767774" name="helpdesk_ticket[custom_field][cf_customer_country_au_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_access_account_ai_767774-label " for="helpdesk_ticket_cf_access_account_ai_767774">Account Number</label>
            <div class="controls   ">
              <input class="  text section_field span12" id="helpdesk_ticket_custom_field_cf_access_account_ai_767774" name="helpdesk_ticket[custom_field][cf_access_account_ai_767774]" size="30" type="text" />
            </div> 
                </div>

<div class="control-group ticket_section">
                   <label class="  control-label cf_reason_of_contact_campus_767774-label " for="helpdesk_ticket_cf_reason_of_contact_campus_767774">Query type</label>
            <div class="controls nested_field  ">
              <select class="  nested_field section_field" id="helpdesk_ticket_custom_field_cf_reason_of_contact_campus_767774_7000162550" name="helpdesk_ticket[custom_field][cf_reason_of_contact_campus_767774]"><option value="">...</option>
<option value="Bugs">Bugs</option>
<option value="Course content">Course content</option>
<option value="Technical issues">Technical issues</option>
<option value="Other">Other</option>
<option value="Trial request">Trial request</option>
<option value="Access issues">Access issues</option>
<option value="Institutional enquiry">Institutional enquiry</option>
<option value="General contact us">General contact us</option>
<option value="Course progress">Course progress</option>
<option value="Delete/manage account">Delete/manage account</option></select><div class="level_2"><label class="">Detail</label><select class="  nested_field section_field" id="helpdesk_ticket_custom_field_cf_detail_campus_767774_7000162550" name="helpdesk_ticket[custom_field][cf_detail_campus_767774]"><option value="">...</option>
</select></div><script type="text/javascript">
//<![CDATA[
jQuery('#helpdesk_ticket_custom_field_cf_reason_of_contact_campus_767774_7000162550').nested_select_tag({"data_tree":[["Bugs","Bugs",[]],["Course content","Course content",[]],["Technical issues","Technical issues",[]],["Other","Other",[["Other","Other",[]]]],["Trial request","Trial request",[]],["Access issues","Access issues",[]],["Institutional enquiry","Institutional enquiry",[]],["General contact us","General contact us",[]],["Course progress","Course progress",[]],["Delete/manage account","Delete/manage account",[]]],"initValues":null,"disable_children":false,"include_blank":"...","selected":null,"pl_value_id":"7000162550","subcategory_id":"helpdesk_ticket_custom_field_cf_detail_campus_767774_7000162550"});
//]]>
</script>
            </div> 
                </div>

<div class="control-group ticket_section">
                   <label class=" required control-label cf_territory_ir_767774-label " for="helpdesk_ticket_cf_territory_ir_767774">Select Territory</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_territory_ir_767774" name="helpdesk_ticket[custom_field][cf_territory_ir_767774]"><option value="">...</option>
<option value="US" data-id="7000161107">US</option>
<option value="ROW" data-id="7000161108">ROW</option></select>
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_institution_ir_767774-label " for="helpdesk_ticket_cf_institution_ir_767774">Institution Name</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_institution_ir_767774" name="helpdesk_ticket[custom_field][cf_institution_ir_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_institution_address_ir_767774-label " for="helpdesk_ticket_cf_institution_address_ir_767774">Institution Address</label>
            <div class="controls   ">
              <textarea class=" required paragraph section_field span12" cols="40" id="helpdesk_ticket_custom_field_cf_institution_address_ir_767774" name="helpdesk_ticket[custom_field][cf_institution_address_ir_767774]" rows="6">
&lt/textarea&gt
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_bill_to_nameaddress_if_different_767774-label " for="helpdesk_ticket_cf_bill_to_nameaddress_if_different_767774">Bill to name/address, if different</label>
            <div class="controls   ">
              <textarea class="  paragraph section_field span12" cols="40" id="helpdesk_ticket_custom_field_cf_bill_to_nameaddress_if_different_767774" name="helpdesk_ticket[custom_field][cf_bill_to_nameaddress_if_different_767774]" rows="6">
&lt/textarea&gt
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_vat_number_ir_767774-label " for="helpdesk_ticket_cf_vat_number_ir_767774">VAT Number (if VAT exempt, please attach VAT Exemption Certificate)</label>
            <div class="controls   ">
              <input class="  text section_field span12" id="helpdesk_ticket_custom_field_cf_vat_number_ir_767774" name="helpdesk_ticket[custom_field][cf_vat_number_ir_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_customer_email_address_ir_767774-label " for="helpdesk_ticket_cf_customer_email_address_ir_767774">Customer Email Address</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_customer_email_address_ir_767774" name="helpdesk_ticket[custom_field][cf_customer_email_address_ir_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_po_number_ir_767774-label " for="helpdesk_ticket_cf_po_number_ir_767774">PO Number</label>
            <div class="controls   ">
              <input class="  text section_field span12" id="helpdesk_ticket_custom_field_cf_po_number_ir_767774" name="helpdesk_ticket[custom_field][cf_po_number_ir_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_sage_catalyst_t276525ebl_net_value_please_provide_the_price_without_tax_tax_on_the_software_portion_will_be_automatically_calculated_by_a2r_and_added_to_this_value_ir_767774-label " for="helpdesk_ticket_cf_sage_catalyst_t276525ebl_net_value_please_provide_the_price_without_tax_tax_on_the_software_portion_will_be_automatically_calculated_by_a2r_and_added_to_this_value_ir_767774">SAGE Catalyst T276525EBL - Net Value (Please provide the price without tax. Tax on the software portion will be automatically calculated by A2R and added to this value).</label>
            <div class="controls   ">
              <input class="  text section_field span12" id="helpdesk_ticket_custom_field_cf_sage_catalyst_t276525ebl_net_value_please_provide_the_price_without_tax_tax_on_the_software_portion_will_be_automatically_calculated_by_a2r_and_added_to_this_value_ir_767774" name="helpdesk_ticket[custom_field][cf_sage_catalyst_t276525ebl_net_value_please_provide_the_price_without_tax_tax_on_the_software_portion_will_be_automatically_calculated_by_a2r_and_added_to_this_value_ir_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_start_date_ir_767774-label " for="helpdesk_ticket_cf_start_date_ir_767774">Start 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_start_date_ir_767774" name="helpdesk_ticket[custom_field][cf_start_date_ir_767774]" readonly="readonly" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_end_date_ir_767774-label " for="helpdesk_ticket_cf_end_date_ir_767774">End 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_end_date_ir_767774" name="helpdesk_ticket[custom_field][cf_end_date_ir_767774]" readonly="readonly" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_currency_ir_767774-label " for="helpdesk_ticket_cf_currency_ir_767774">Currency</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_currency_ir_767774" name="helpdesk_ticket[custom_field][cf_currency_ir_767774]"><option value="">...</option>
<option value="USD" data-id="7000161109">USD</option>
<option value="GBP" data-id="7000161110">GBP</option></select>
            </div> 
                </div>

<div class="control-group ticket_section">
                   <label class=" required control-label cf_redemption_code_if_767774-label " for="helpdesk_ticket_cf_redemption_code_if_767774">Redemption code</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_redemption_code_if_767774" name="helpdesk_ticket[custom_field][cf_redemption_code_if_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_ship_to_name_eb_767774-label " for="helpdesk_ticket_cf_ship_to_name_eb_767774">Ship to first and last name</label>
            <div class="controls   ">
              <input class="  text section_field span12" id="helpdesk_ticket_custom_field_cf_ship_to_name_eb_767774" name="helpdesk_ticket[custom_field][cf_ship_to_name_eb_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_ship_to_address_line_1_if_767774-label " for="helpdesk_ticket_cf_ship_to_address_line_1_if_767774">Home/residential address line 1</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_ship_to_address_line_1_if_767774" name="helpdesk_ticket[custom_field][cf_ship_to_address_line_1_if_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_homeresidential_address_line_2_if_767774-label " for="helpdesk_ticket_cf_homeresidential_address_line_2_if_767774">Home/residential address line 2</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_homeresidential_address_line_2_if_767774" name="helpdesk_ticket[custom_field][cf_homeresidential_address_line_2_if_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_homeresidential_city_if_767774-label " for="helpdesk_ticket_cf_homeresidential_city_if_767774">Home/residential city</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_homeresidential_city_if_767774" name="helpdesk_ticket[custom_field][cf_homeresidential_city_if_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_shipping_state_if_767774-label " for="helpdesk_ticket_cf_shipping_state_if_767774">Home/residential state</label>
            <div class="controls   ">
              <input class="  text section_field span12" id="helpdesk_ticket_custom_field_cf_shipping_state_if_767774" name="helpdesk_ticket[custom_field][cf_shipping_state_if_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_shipping_country_if_767774-label " for="helpdesk_ticket_cf_shipping_country_if_767774">Home/residential country</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_shipping_country_if_767774" name="helpdesk_ticket[custom_field][cf_shipping_country_if_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_ship_to_phone_eb_767774-label " for="helpdesk_ticket_cf_ship_to_phone_eb_767774">Ship to phone (include country code)</label>
            <div class="controls   ">
              <input class="  text section_field span12" id="helpdesk_ticket_custom_field_cf_ship_to_phone_eb_767774" name="helpdesk_ticket[custom_field][cf_ship_to_phone_eb_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_produc_767774-label " for="helpdesk_ticket_cf_produc_767774">Product 1 ISBN</label>
            <div class="controls   ">
              <input class=" required number section_field span12" id="helpdesk_ticket_custom_field_cf_produc_767774" name="helpdesk_ticket[custom_field][cf_produc_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_product_1_title_author_if_767774-label " for="helpdesk_ticket_cf_product_1_title_author_if_767774">Product 1 Title & Author</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_product_1_title_author_if_767774" name="helpdesk_ticket[custom_field][cf_product_1_title_author_if_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_product_2_isbn_eb_767774-label " for="helpdesk_ticket_cf_product_2_isbn_eb_767774">Product 2 ISBN</label>
            <div class="controls   ">
              <input class="  number section_field span12" id="helpdesk_ticket_custom_field_cf_product_2_isbn_eb_767774" name="helpdesk_ticket[custom_field][cf_product_2_isbn_eb_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_product_2_title_author_if_767774-label " for="helpdesk_ticket_cf_product_2_title_author_if_767774">Product 2 Title & Author</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_product_2_title_author_if_767774" name="helpdesk_ticket[custom_field][cf_product_2_title_author_if_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_product_isbn_3_eb_767774-label " for="helpdesk_ticket_cf_product_isbn_3_eb_767774">Product 3 ISBN</label>
            <div class="controls   ">
              <input class="  number section_field span12" id="helpdesk_ticket_custom_field_cf_product_isbn_3_eb_767774" name="helpdesk_ticket[custom_field][cf_product_isbn_3_eb_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_product_3_title_author_767774-label " for="helpdesk_ticket_cf_product_3_title_author_767774">Product 3 Title & Author</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_product_3_title_author_767774" name="helpdesk_ticket[custom_field][cf_product_3_title_author_767774]" size="30" type="text" />
            </div> 
                </div>

<div class="control-group ticket_section">
                   <label class=" required control-label cf_where_are_you_sales_team_located_eb_767774-label " for="helpdesk_ticket_cf_where_are_you_sales_team_located_eb_767774">Where are you (sales team) located?</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_where_are_you_sales_team_located_eb_767774" name="helpdesk_ticket[custom_field][cf_where_are_you_sales_team_located_eb_767774]"><option value="">...</option>
<option value="North, Central and South America" data-id="7000170986">North, Central and South America</option>
<option value="In Europe, Africa, Asia and Oceania" data-id="7000170987">In Europe, Africa, Asia and Oceania</option></select>
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_platform_eb103278_767774-label " for="helpdesk_ticket_cf_platform_eb103278_767774">Platform</label>
            <div class="controls nested_field  ">
              <select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_platform_eb103278_767774_7000162519" name="helpdesk_ticket[custom_field][cf_platform_eb103278_767774]"><option value="">...</option>
<option value="VitalSource">VitalSource</option>
<option value="Redshelf">Redshelf</option>
<option value="Other">Other</option></select><div class="level_2"><label class="required">Product Type</label><select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_product_type_eb_767774_7000162519" name="helpdesk_ticket[custom_field][cf_product_type_eb_767774]"><option value="">...</option>
</select></div><script type="text/javascript">
//<![CDATA[
jQuery('#helpdesk_ticket_custom_field_cf_platform_eb103278_767774_7000162519').nested_select_tag({"data_tree":[["VitalSource","VitalSource",[["VitalSource codes","VitalSource codes",[]],["VitalSource VLE integration","VitalSource VLE integration",[]],["VitalSource Explore","VitalSource Explore",[]],["Other","Other",[]]]],["Redshelf","Redshelf",[]],["Other","Other",[]]],"initValues":null,"disable_children":false,"include_blank":"...","selected":null,"pl_value_id":"7000162519","subcategory_id":"helpdesk_ticket_custom_field_cf_product_type_eb_767774_7000162519"});
//]]>
</script>
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_existing_customer_account_number_eb_767774-label " for="helpdesk_ticket_cf_existing_customer_account_number_eb_767774">If existing customer, provide account number</label>
            <div class="controls   ">
              <input class="  text section_field span12" id="helpdesk_ticket_custom_field_cf_existing_customer_account_number_eb_767774" name="helpdesk_ticket[custom_field][cf_existing_customer_account_number_eb_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_bill_to_name_767774-label " for="helpdesk_ticket_cf_bill_to_name_767774">Bill to name</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_bill_to_name_767774" name="helpdesk_ticket[custom_field][cf_bill_to_name_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_bill_to_address_line_1_767774-label " for="helpdesk_ticket_cf_bill_to_address_line_1_767774">Bill to address line 1</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_bill_to_address_line_1_767774" name="helpdesk_ticket[custom_field][cf_bill_to_address_line_1_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_bill_to_address_line_2_eb_767774-label " for="helpdesk_ticket_cf_bill_to_address_line_2_eb_767774">Bill to address line 2</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_bill_to_address_line_2_eb_767774" name="helpdesk_ticket[custom_field][cf_bill_to_address_line_2_eb_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_bill_to_city_eb_767774-label " for="helpdesk_ticket_cf_bill_to_city_eb_767774">Bill to city</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_bill_to_city_eb_767774" name="helpdesk_ticket[custom_field][cf_bill_to_city_eb_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_bill_to_state_eb_767774-label " for="helpdesk_ticket_cf_bill_to_state_eb_767774">Bill to state</label>
            <div class="controls   ">
              <input class="  text section_field span12" id="helpdesk_ticket_custom_field_cf_bill_to_state_eb_767774" name="helpdesk_ticket[custom_field][cf_bill_to_state_eb_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_bill_to_territory_eb_767774-label " for="helpdesk_ticket_cf_bill_to_territory_eb_767774">Bill to territory</label>
            <div class="controls nested_field  ">
              <select class="  nested_field section_field" id="helpdesk_ticket_custom_field_cf_bill_to_territory_eb_767774_7000162519" name="helpdesk_ticket[custom_field][cf_bill_to_territory_eb_767774]"><option value="">...</option>
<option value="AP">AP</option>
<option value="GB">GB</option>
<option value="IN">IN</option>
<option value="US">US</option></select><div class="level_2"><label class="">Bill to country</label><select class="  nested_field section_field" id="helpdesk_ticket_custom_field_cf_bill_to_country_eb_767774_7000162519" name="helpdesk_ticket[custom_field][cf_bill_to_country_eb_767774]"><option value="">...</option>
</select></div><script type="text/javascript">
//<![CDATA[
jQuery('#helpdesk_ticket_custom_field_cf_bill_to_territory_eb_767774_7000162519').nested_select_tag({"data_tree":[["AP","AP",[["American Samoa","American Samoa",[]],["Australia","Australia",[]],["British Indian Ocean Territory","British Indian Ocean Territory",[]],["Brunei Darussalam","Brunei Darussalam",[]],["Cambodia","Cambodia",[]],["Caroline Islands","Caroline Islands",[]],["China","China",[]],["Christmas Island","Christmas Island",[]],["Cook Islands","Cook Islands",[]],["East Timor","East Timor",[]],["Fiji","Fiji",[]],["French Polynesia","French Polynesia",[]],["Guam","Guam",[]],["Heard and McDonald Islands","Heard and McDonald Islands",[]],["Hong Kong","Hong Kong",[]],["Indonesia","Indonesia",[]],["Japan","Japan",[]],["Kiribati","Kiribati",[]],["Korea, Democratic People's Republic","Korea, Democratic People's Republic",[]],["Lao People's Democratic Republic","Lao People's Democratic Republic",[]],["Macau","Macau",[]],["Malaysia","Malaysia",[]],["Marshall Islands","Marshall Islands",[]],["Micronesia, Federated States of","Micronesia, Federated States of",[]],["Mongolia","Mongolia",[]],["Myanmar","Myanmar",[]],["Nauru","Nauru",[]],["New Caledonia","New Caledonia",[]],["New Zealand","New Zealand",[]],["Niue","Niue",[]],["Norfolk Island","Norfolk Island",[]],["Northern Mariana Islands","Northern Mariana Islands",[]],["Palau","Palau",[]],["Papua New Guinea","Papua New Guinea",[]],["Philippines","Philippines",[]],["Pitcairn","Pitcairn",[]],["Republic Of Korea","Republic Of Korea",[]],["Samoa","Samoa",[]],["Singapore","Singapore",[]],["Solomon Islands","Solomon Islands",[]],["Taiwan. Republic of China","Taiwan. Republic of China",[]],["Thailand","Thailand",[]],["Tokelau","Tokelau",[]],["Tonga","Tonga",[]],["Tuvalu","Tuvalu",[]],["Vanuatu","Vanuatu",[]],["Vietnam","Vietnam",[]],["Wallis and Futuna Islands","Wallis and Futuna Islands",[]]]],["GB","GB",[["Afghanistan","Afghanistan",[]],["Albania","Albania",[]],["Algeria","Algeria",[]],["Andorra","Andorra",[]],["Angola","Angola",[]],["Armenia","Armenia",[]],["Austria","Austria",[]],["Azerbaijan","Azerbaijan",[]],["Bahrain","Bahrain",[]],["Belarus","Belarus",[]],["Belgium","Belgium",[]],["Benin","Benin",[]],["Bosnia and Herzegowina","Bosnia and Herzegowina",[]],["Botswana","Botswana",[]],["Bouvet Island","Bouvet Island",[]],["Bulgaria","Bulgaria",[]],["Burkina Faso","Burkina Faso",[]],["Burundi","Burundi",[]],["Cameroon","Cameroon",[]],["Cape Verde","Cape Verde",[]],["Central African Republic","Central African Republic",[]],["Chad","Chad",[]],["Comoros","Comoros",[]],["Congo","Congo",[]],["Congo, The Democratic Republic of the","Congo, The 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State)",[]],["Hungary","Hungary",[]],["Iceland","Iceland",[]],["Iran (Islamic Republic of)","Iran (Islamic Republic of)",[]],["Iraq","Iraq",[]],["Ireland","Ireland",[]],["Isle of Man","Isle of Man",[]],["Israel","Israel",[]],["Italy","Italy",[]],["Jersey","Jersey",[]],["Jordan","Jordan",[]],["Kazakhstan","Kazakhstan",[]],["Kenya","Kenya",[]],["Kuwait","Kuwait",[]],["Kyrgyzstan","Kyrgyzstan",[]],["Latvia","Latvia",[]],["Lebanon","Lebanon",[]],["Lesotho","Lesotho",[]],["Liberia","Liberia",[]],["Libyan Arab Jamahiriya","Libyan Arab Jamahiriya",[]],["Liechtenstein","Liechtenstein",[]],["Lithuania","Lithuania",[]],["Luxembourg","Luxembourg",[]],["Macedonia, The Former Yugoslav Republic","Macedonia, The Former Yugoslav Republic",[]],["Madagascar","Madagascar",[]],["Malawi","Malawi",[]],["Mali","Mali",[]],["Malta","Malta",[]],["Mauritania","Mauritania",[]],["Mauritius","Mauritius",[]],["Mayotte","Mayotte",[]],["Moldova, Republic of","Moldova, Republic of",[]],["Monaco","Monaco",[]],["Montenegro","Montenegro",[]],["Morocco","Morocco",[]],["Mozambique","Mozambique",[]],["Namibia","Namibia",[]],["Netherlands","Netherlands",[]],["Niger","Niger",[]],["Nigeria","Nigeria",[]],["Northern Ireland","Northern Ireland",[]],["Norway","Norway",[]],["Oman","Oman",[]],["Palestine","Palestine",[]],["Poland","Poland",[]],["Portugal","Portugal",[]],["Qatar","Qatar",[]],["Rep of Kosovo","Rep of Kosovo",[]],["Reunion","Reunion",[]],["Romania","Romania",[]],["Russian Federation","Russian Federation",[]],["Rwanda","Rwanda",[]],["San Marino","San Marino",[]],["Sao Tome and Principe","Sao Tome and Principe",[]],["Saudi Arabia","Saudi Arabia",[]],["Senegal","Senegal",[]],["Serbia","Serbia",[]],["Seychelles","Seychelles",[]],["Sierra Leone","Sierra Leone",[]],["Slovakia(Slovak Republic)","Slovakia(Slovak Republic)",[]],["Slovenia","Slovenia",[]],["Somalia","Somalia",[]],["South Africa","South Africa",[]],["South Sudan","South Sudan",[]],["Spain","Spain",[]],["St Helena","St Helena",[]],["Sudan","Sudan",[]],["Svalbard and Jan Mayen Islands","Svalbard and Jan Mayen Islands",[]],["Swaziland","Swaziland",[]],["Sweden","Sweden",[]],["Switzerland","Switzerland",[]],["Syrian Arab Republic","Syrian Arab Republic",[]],["Tajikistan","Tajikistan",[]],["Tanzania","Tanzania",[]],["Togo","Togo",[]],["Tunisia","Tunisia",[]],["Turkey","Turkey",[]],["Turkmenistan","Turkmenistan",[]],["Uganda","Uganda",[]],["Ukraine","Ukraine",[]],["United Arab Emirates","United Arab Emirates",[]],["Uzbekistan","Uzbekistan",[]],["Western Sahara","Western Sahara",[]],["Yemen","Yemen",[]],["Yugoslavia","Yugoslavia",[]],["Zambia","Zambia",[]],["Zimbabwe","Zimbabwe",[]],["Sri Lanka","Sri Lanka",[]],["Pakistan","Pakistan",[]]]],["IN","IN",[["Bangladesh","Bangladesh",[]],["Bhutan","Bhutan",[]],["Cocos (Keeling) Islands","Cocos (Keeling) Islands",[]],["India","India",[]],["Maldives","Maldives",[]],["Nepal","Nepal",[]]]],["US","US",[["Anguilla","Anguilla",[]],["Antarctica","Antarctica",[]],["Antigua and Barbuda","Antigua and Barbuda",[]],["Argentina","Argentina",[]],["Aruba","Aruba",[]],["Bahamas","Bahamas",[]],["Barbados","Barbados",[]],["Belize","Belize",[]],["Bermuda","Bermuda",[]],["Bolivia","Bolivia",[]],["Brazil","Brazil",[]],["Canada","Canada",[]],["Cayman Islands","Cayman Islands",[]],["Chile","Chile",[]],["Colombia","Colombia",[]],["Costa Rica","Costa Rica",[]],["Cuba","Cuba",[]],["Dominica","Dominica",[]],["Dominican Republic","Dominican Republic",[]],["Ecuador","Ecuador",[]],["El Salvador","El Salvador",[]],["Falkland Islands (Malvinas)","Falkland Islands (Malvinas)",[]],["French Antilles","French Antilles",[]],["French Guiana","French 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America",[]],["Uruguay","Uruguay",[]],["Venezuela","Venezuela",[]],["Virgin Islands (British)","Virgin Islands (British)",[]],["Virgin Islands (U.S.)","Virgin Islands (U.S.)",[]],["West Indies","West Indies",[]]]]],"initValues":null,"disable_children":false,"include_blank":"...","selected":null,"pl_value_id":"7000162519","subcategory_id":"helpdesk_ticket_custom_field_cf_bill_to_country_eb_767774_7000162519"});
//]]>
</script>
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_bill_to_tax_id_eb_767774-label " for="helpdesk_ticket_cf_bill_to_tax_id_eb_767774">Bill to Tax ID. If in US, please attach Tax Certificate below</label>
            <div class="controls   ">
              <input class="  text section_field span12" id="helpdesk_ticket_custom_field_cf_bill_to_tax_id_eb_767774" name="helpdesk_ticket[custom_field][cf_bill_to_tax_id_eb_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_bill_to_email_address_eb_767774-label " for="helpdesk_ticket_cf_bill_to_email_address_eb_767774">Bill to email address</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_bill_to_email_address_eb_767774" name="helpdesk_ticket[custom_field][cf_bill_to_email_address_eb_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_bill_to_phone_number_eb_767774-label " for="helpdesk_ticket_cf_bill_to_phone_number_eb_767774">Bill to phone number</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_bill_to_phone_number_eb_767774" name="helpdesk_ticket[custom_field][cf_bill_to_phone_number_eb_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_is_bill_to_the_same_as_ship_to_eb_767774-label " for="helpdesk_ticket_cf_is_bill_to_the_same_as_ship_to_eb_767774">Is bill to the same as ship to?</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_is_bill_to_the_same_as_ship_to_eb_767774" name="helpdesk_ticket[custom_field][cf_is_bill_to_the_same_as_ship_to_eb_767774]"><option value="">...</option>
<option value="Yes" data-id="7000170170">Yes</option>
<option value="No" data-id="7000170171">No</option></select>
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_ship_to_name_eb_767774-label " for="helpdesk_ticket_cf_ship_to_name_eb_767774">Ship to first and last name</label>
            <div class="controls   ">
              <input class="  text section_field span12" id="helpdesk_ticket_custom_field_cf_ship_to_name_eb_767774" name="helpdesk_ticket[custom_field][cf_ship_to_name_eb_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_ship_to_address_line_1_eb_767774-label " for="helpdesk_ticket_cf_ship_to_address_line_1_eb_767774">Ship to address line 1</label>
            <div class="controls   ">
              <input class="  text section_field span12" id="helpdesk_ticket_custom_field_cf_ship_to_address_line_1_eb_767774" name="helpdesk_ticket[custom_field][cf_ship_to_address_line_1_eb_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_ship_to_address_line_2_eb_767774-label " for="helpdesk_ticket_cf_ship_to_address_line_2_eb_767774">Ship to address line 2</label>
            <div class="controls   ">
              <input class="  text section_field span12" id="helpdesk_ticket_custom_field_cf_ship_to_address_line_2_eb_767774" name="helpdesk_ticket[custom_field][cf_ship_to_address_line_2_eb_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_ship_to_city_eb_767774-label " for="helpdesk_ticket_cf_ship_to_city_eb_767774">Ship to city</label>
            <div class="controls   ">
              <input class="  text section_field span12" id="helpdesk_ticket_custom_field_cf_ship_to_city_eb_767774" name="helpdesk_ticket[custom_field][cf_ship_to_city_eb_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_ship_to_state_eb_767774-label " for="helpdesk_ticket_cf_ship_to_state_eb_767774">Ship to state</label>
            <div class="controls   ">
              <input class="  text section_field span12" id="helpdesk_ticket_custom_field_cf_ship_to_state_eb_767774" name="helpdesk_ticket[custom_field][cf_ship_to_state_eb_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_ship_to_country_eb_767774-label " for="helpdesk_ticket_cf_ship_to_country_eb_767774">Ship to country</label>
            <div class="controls   ">
              <input class="  text section_field span12" id="helpdesk_ticket_custom_field_cf_ship_to_country_eb_767774" name="helpdesk_ticket[custom_field][cf_ship_to_country_eb_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_ship_to_email_eb_767774-label " for="helpdesk_ticket_cf_ship_to_email_eb_767774">Ship to email address</label>
            <div class="controls   ">
              <input class="  text section_field span12" id="helpdesk_ticket_custom_field_cf_ship_to_email_eb_767774" name="helpdesk_ticket[custom_field][cf_ship_to_email_eb_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_ship_to_phone_eb_767774-label " for="helpdesk_ticket_cf_ship_to_phone_eb_767774">Ship to phone (include country code)</label>
            <div class="controls   ">
              <input class="  text section_field span12" id="helpdesk_ticket_custom_field_cf_ship_to_phone_eb_767774" name="helpdesk_ticket[custom_field][cf_ship_to_phone_eb_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_list_or_net_price_if_767774-label " for="helpdesk_ticket_cf_list_or_net_price_if_767774">Are you providing price as List or Net?</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_list_or_net_price_if_767774" name="helpdesk_ticket[custom_field][cf_list_or_net_price_if_767774]"><option value="">...</option>
<option value="List" data-id="7000172792">List</option>
<option value="Net" data-id="7000172793">Net</option></select>
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_produc_767774-label " for="helpdesk_ticket_cf_produc_767774">Product 1 ISBN</label>
            <div class="controls   ">
              <input class=" required number section_field span12" id="helpdesk_ticket_custom_field_cf_produc_767774" name="helpdesk_ticket[custom_field][cf_produc_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_product_quantity_eb_767774-label " for="helpdesk_ticket_cf_product_quantity_eb_767774">Product 1 quantity</label>
            <div class="controls   ">
              <input class=" required number section_field span12" id="helpdesk_ticket_custom_field_cf_product_quantity_eb_767774" name="helpdesk_ticket[custom_field][cf_product_quantity_eb_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_product_1_price_if_767774-label " for="helpdesk_ticket_cf_product_1_price_if_767774">Product 1 price</label>
            <div class="controls   ">
              <input class=" required decimal section_field span12" id="helpdesk_ticket_custom_field_cf_product_1_price_if_767774" name="helpdesk_ticket[custom_field][cf_product_1_price_if_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_product_2_isbn_eb_767774-label " for="helpdesk_ticket_cf_product_2_isbn_eb_767774">Product 2 ISBN</label>
            <div class="controls   ">
              <input class="  number section_field span12" id="helpdesk_ticket_custom_field_cf_product_2_isbn_eb_767774" name="helpdesk_ticket[custom_field][cf_product_2_isbn_eb_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_product_2_quantity_eb_767774-label " for="helpdesk_ticket_cf_product_2_quantity_eb_767774">Product 2 quantity</label>
            <div class="controls   ">
              <input class="  number section_field span12" id="helpdesk_ticket_custom_field_cf_product_2_quantity_eb_767774" name="helpdesk_ticket[custom_field][cf_product_2_quantity_eb_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_product_2_price_if_767774-label " for="helpdesk_ticket_cf_product_2_price_if_767774">Product 2 price</label>
            <div class="controls   ">
              <input class="  decimal section_field span12" id="helpdesk_ticket_custom_field_cf_product_2_price_if_767774" name="helpdesk_ticket[custom_field][cf_product_2_price_if_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_product_isbn_3_eb_767774-label " for="helpdesk_ticket_cf_product_isbn_3_eb_767774">Product 3 ISBN</label>
            <div class="controls   ">
              <input class="  number section_field span12" id="helpdesk_ticket_custom_field_cf_product_isbn_3_eb_767774" name="helpdesk_ticket[custom_field][cf_product_isbn_3_eb_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_product_3_quantity_eb_767774-label " for="helpdesk_ticket_cf_product_3_quantity_eb_767774">Product 3 quantity</label>
            <div class="controls   ">
              <input class="  number section_field span12" id="helpdesk_ticket_custom_field_cf_product_3_quantity_eb_767774" name="helpdesk_ticket[custom_field][cf_product_3_quantity_eb_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_product_3_price_if_767774-label " for="helpdesk_ticket_cf_product_3_price_if_767774">Product 3 price</label>
            <div class="controls   ">
              <input class="  decimal section_field span12" id="helpdesk_ticket_custom_field_cf_product_3_price_if_767774" name="helpdesk_ticket[custom_field][cf_product_3_price_if_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_product_4_isbn_eb_767774-label " for="helpdesk_ticket_cf_product_4_isbn_eb_767774">Product 4 ISBN</label>
            <div class="controls   ">
              <input class="  number section_field span12" id="helpdesk_ticket_custom_field_cf_product_4_isbn_eb_767774" name="helpdesk_ticket[custom_field][cf_product_4_isbn_eb_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_product_4_quantity_eb_767774-label " for="helpdesk_ticket_cf_product_4_quantity_eb_767774">Product 4 quantity</label>
            <div class="controls   ">
              <input class="  number section_field span12" id="helpdesk_ticket_custom_field_cf_product_4_quantity_eb_767774" name="helpdesk_ticket[custom_field][cf_product_4_quantity_eb_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_product_4_price_if_767774-label " for="helpdesk_ticket_cf_product_4_price_if_767774">Product 4 price</label>
            <div class="controls   ">
              <input class="  decimal section_field span12" id="helpdesk_ticket_custom_field_cf_product_4_price_if_767774" name="helpdesk_ticket[custom_field][cf_product_4_price_if_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_product_5_isbn_eb_767774-label " for="helpdesk_ticket_cf_product_5_isbn_eb_767774">Product 5 ISBN</label>
            <div class="controls   ">
              <input class="  number section_field span12" id="helpdesk_ticket_custom_field_cf_product_5_isbn_eb_767774" name="helpdesk_ticket[custom_field][cf_product_5_isbn_eb_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_product_4_quantity_eb743296_767774-label " for="helpdesk_ticket_cf_product_4_quantity_eb743296_767774">Product 5 quantity</label>
            <div class="controls   ">
              <input class="  number section_field span12" id="helpdesk_ticket_custom_field_cf_product_4_quantity_eb743296_767774" name="helpdesk_ticket[custom_field][cf_product_4_quantity_eb743296_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_product_5_price_if_767774-label " for="helpdesk_ticket_cf_product_5_price_if_767774">Product 5 price</label>
            <div class="controls   ">
              <input class="  decimal section_field span12" id="helpdesk_ticket_custom_field_cf_product_5_price_if_767774" name="helpdesk_ticket[custom_field][cf_product_5_price_if_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_discretionary_discount_eb_767774-label " for="helpdesk_ticket_cf_discretionary_discount_eb_767774">Discretionary discount, if applicable (%)</label>
            <div class="controls   ">
              <input class="  text section_field span12" id="helpdesk_ticket_custom_field_cf_discretionary_discount_eb_767774" name="helpdesk_ticket[custom_field][cf_discretionary_discount_eb_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_comments_to_be_included_on_invoice_eb_767774-label " for="helpdesk_ticket_cf_comments_to_be_included_on_invoice_eb_767774">Comments to be included on invoice (maximum 400 characters)</label>
            <div class="controls   ">
              <textarea class="  paragraph section_field span12" cols="40" id="helpdesk_ticket_custom_field_cf_comments_to_be_included_on_invoice_eb_767774" name="helpdesk_ticket[custom_field][cf_comments_to_be_included_on_invoice_eb_767774]" rows="6">
&lt/textarea&gt
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_customer_type_author_yn_eb_767774-label " for="helpdesk_ticket_cf_customer_type_author_yn_eb_767774">Customer Type: Author? (Y/N)</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_customer_type_author_yn_eb_767774" name="helpdesk_ticket[custom_field][cf_customer_type_author_yn_eb_767774]"><option value="">...</option>
<option value="Yes - Author" data-id="7000168975">Yes - Author</option>
<option value="No - Author" data-id="7000168976">No - Author</option></select>
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_currency_for_billing_eb_767774-label " for="helpdesk_ticket_cf_currency_for_billing_eb_767774">Currency for billing</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_currency_for_billing_eb_767774" name="helpdesk_ticket[custom_field][cf_currency_for_billing_eb_767774]"><option value="">...</option>
<option value="USD" data-id="7000168977">USD</option>
<option value="GBP" data-id="7000168978">GBP</option>
<option value="AUD" data-id="7000171240">AUD</option>
<option value="EUR" data-id="7000171241">EUR</option>
<option value="CAD" data-id="7000171242">CAD</option></select>
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_po_number_eb_767774-label " for="helpdesk_ticket_cf_po_number_eb_767774">PO Number - Please attach PDF of PO below</label>
            <div class="controls   ">
              <input class="  text section_field span12" id="helpdesk_ticket_custom_field_cf_po_number_eb_767774" name="helpdesk_ticket[custom_field][cf_po_number_eb_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_sales_require_copy_if_767774-label " for="helpdesk_ticket_cf_sales_require_copy_if_767774">Do you (Sales) require copy?</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_sales_require_copy_if_767774" name="helpdesk_ticket[custom_field][cf_sales_require_copy_if_767774]"><option value="">...</option>
<option value="Yes" data-id="7000172387">Yes</option>
<option value="No" data-id="7000172388">No</option></select>
            </div> 
                </div>

<div class="control-group ticket_section">
                   <label class="  control-label cf_phone_sv_767774-label " for="helpdesk_ticket_cf_phone_sv_767774">Contact Number (Optional. In case we have questions)</label>
            <div class="controls   ">
              <input class="  text section_field span12" id="helpdesk_ticket_custom_field_cf_phone_sv_767774" name="helpdesk_ticket[custom_field][cf_phone_sv_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_institution_name_sv_767774-label " for="helpdesk_ticket_cf_institution_name_sv_767774">Institution Name</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_institution_name_sv_767774" name="helpdesk_ticket[custom_field][cf_institution_name_sv_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_institution_address_sv_767774-label " for="helpdesk_ticket_cf_institution_address_sv_767774">Institution Address</label>
            <div class="controls   ">
              <textarea class=" required paragraph section_field span12" cols="40" id="helpdesk_ticket_custom_field_cf_institution_address_sv_767774" name="helpdesk_ticket[custom_field][cf_institution_address_sv_767774]" rows="6">
&lt/textarea&gt
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_ip_addresses_sv_767774-label " for="helpdesk_ticket_cf_ip_addresses_sv_767774">IP Addresses</label>
            <div class="controls   ">
              <textarea class=" required paragraph section_field span12" cols="40" id="helpdesk_ticket_custom_field_cf_ip_addresses_sv_767774" name="helpdesk_ticket[custom_field][cf_ip_addresses_sv_767774]" rows="6">
&lt/textarea&gt
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_shibboleth_or_open_athens_set_up_information_sv_free_access_767774-label " for="helpdesk_ticket_cf_shibboleth_or_open_athens_set_up_information_sv_free_access_767774">Shibboleth or Open Athens set up information</label>
            <div class="controls   ">
              <textarea class="  paragraph section_field span12" cols="40" id="helpdesk_ticket_custom_field_cf_shibboleth_or_open_athens_set_up_information_sv_free_access_767774" name="helpdesk_ticket[custom_field][cf_shibboleth_or_open_athens_set_up_information_sv_free_access_767774]" rows="6">
&lt/textarea&gt
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_institution_country_sv_767774-label " for="helpdesk_ticket_cf_institution_country_sv_767774">Institution Country</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_institution_country_sv_767774" name="helpdesk_ticket[custom_field][cf_institution_country_sv_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                    <div class="controls">
            <label class="checkbox ">
              <input name="helpdesk_ticket[custom_field][cf_business_amp_management_767774]" type="hidden" value="0" /><input class="  checkbox section_field" id="helpdesk_ticket_custom_field_cf_business_amp_management_767774_7000149649" name="helpdesk_ticket[custom_field][cf_business_amp_management_767774]" type="checkbox" value="1" /> SAGE Video Business &amp; Management Collection
            </label>
          </div> 
                </div>
                <div class="control-group ticket_section">
                    <div class="controls">
            <label class="checkbox ">
              <input name="helpdesk_ticket[custom_field][cf_counseling_amp_psychotherapy_767774]" type="hidden" value="0" /><input class="  checkbox section_field" id="helpdesk_ticket_custom_field_cf_counseling_amp_psychotherapy_767774_7000149649" name="helpdesk_ticket[custom_field][cf_counseling_amp_psychotherapy_767774]" type="checkbox" value="1" /> SAGE Video Counseling &amp; Psychotherapy Collection
            </label>
          </div> 
                </div>
                <div class="control-group ticket_section">
                    <div class="controls">
            <label class="checkbox ">
              <input name="helpdesk_ticket[custom_field][cf_criminology_amp_criminal_justice_767774]" type="hidden" value="0" /><input class="  checkbox section_field" id="helpdesk_ticket_custom_field_cf_criminology_amp_criminal_justice_767774_7000149649" name="helpdesk_ticket[custom_field][cf_criminology_amp_criminal_justice_767774]" type="checkbox" value="1" /> SAGE Video Criminology &amp; Criminal Justice Collection
            </label>
          </div> 
                </div>
                <div class="control-group ticket_section">
                    <div class="controls">
            <label class="checkbox ">
              <input name="helpdesk_ticket[custom_field][cf_education_767774]" type="hidden" value="0" /><input class="  checkbox section_field" id="helpdesk_ticket_custom_field_cf_education_767774_7000149649" name="helpdesk_ticket[custom_field][cf_education_767774]" type="checkbox" value="1" /> SAGE Video Education Collection
            </label>
          </div> 
                </div>
                <div class="control-group ticket_section">
                    <div class="controls">
            <label class="checkbox ">
              <input name="helpdesk_ticket[custom_field][cf_leadership_767774]" type="hidden" value="0" /><input class="  checkbox section_field" id="helpdesk_ticket_custom_field_cf_leadership_767774_7000149649" name="helpdesk_ticket[custom_field][cf_leadership_767774]" type="checkbox" value="1" /> SAGE Video Leadership Collection
            </label>
          </div> 
                </div>
                <div class="control-group ticket_section">
                    <div class="controls">
            <label class="checkbox ">
              <input name="helpdesk_ticket[custom_field][cf_media_communication_amp_cultural_studies_767774]" type="hidden" value="0" /><input class="  checkbox section_field" id="helpdesk_ticket_custom_field_cf_media_communication_amp_cultural_studies_767774_7000149649" name="helpdesk_ticket[custom_field][cf_media_communication_amp_cultural_studies_767774]" type="checkbox" value="1" /> SAGE Video Media, Communication, &amp; Cultural Studies Collection
            </label>
          </div> 
                </div>
                <div class="control-group ticket_section">
                    <div class="controls">
            <label class="checkbox ">
              <input name="helpdesk_ticket[custom_field][cf_nursing_767774]" type="hidden" value="0" /><input class="  checkbox section_field" id="helpdesk_ticket_custom_field_cf_nursing_767774_7000149649" name="helpdesk_ticket[custom_field][cf_nursing_767774]" type="checkbox" value="1" /> SAGE Video Nursing Collection
            </label>
          </div> 
                </div>
                <div class="control-group ticket_section">
                    <div class="controls">
            <label class="checkbox ">
              <input name="helpdesk_ticket[custom_field][cf_politics_amp_international_relations_767774]" type="hidden" value="0" /><input class="  checkbox section_field" id="helpdesk_ticket_custom_field_cf_politics_amp_international_relations_767774_7000149649" name="helpdesk_ticket[custom_field][cf_politics_amp_international_relations_767774]" type="checkbox" value="1" /> SAGE Video Politics &amp; International Relations Collection
            </label>
          </div> 
                </div>
                <div class="control-group ticket_section">
                    <div class="controls">
            <label class="checkbox ">
              <input name="helpdesk_ticket[custom_field][cf_psychology_767774]" type="hidden" value="0" /><input class="  checkbox section_field" id="helpdesk_ticket_custom_field_cf_psychology_767774_7000149649" name="helpdesk_ticket[custom_field][cf_psychology_767774]" type="checkbox" value="1" /> SAGE Video Psychology Collection
            </label>
          </div> 
                </div>
                <div class="control-group ticket_section">
                    <div class="controls">
            <label class="checkbox ">
              <input name="helpdesk_ticket[custom_field][cf_sociology_767774]" type="hidden" value="0" /><input class="  checkbox section_field" id="helpdesk_ticket_custom_field_cf_sociology_767774_7000149649" name="helpdesk_ticket[custom_field][cf_sociology_767774]" type="checkbox" value="1" /> SAGE Video Sociology Collection
            </label>
          </div> 
                </div>
                <div class="control-group ticket_section">
                    <div class="controls">
            <label class="checkbox ">
              <input name="helpdesk_ticket[custom_field][cf_social_work_767774]" type="hidden" value="0" /><input class="  checkbox section_field" id="helpdesk_ticket_custom_field_cf_social_work_767774_7000149649" name="helpdesk_ticket[custom_field][cf_social_work_767774]" type="checkbox" value="1" /> SAGE Video Social Work Collection
            </label>
          </div> 
                </div>
                <div class="control-group ticket_section">
                    <div class="controls">
            <label class="checkbox ">
              <input name="helpdesk_ticket[custom_field][cf_research_methods_767774]" type="hidden" value="0" /><input class="  checkbox section_field" id="helpdesk_ticket_custom_field_cf_research_methods_767774_7000149649" name="helpdesk_ticket[custom_field][cf_research_methods_767774]" type="checkbox" value="1" /> SAGE Research Methods Video Collection
            </label>
          </div> 
                </div>
                <div class="control-group ticket_section">
                    <div class="controls">
            <label class="checkbox ">
              <input name="helpdesk_ticket[custom_field][cf_sage_video_research_methods_sv_767774]" type="hidden" value="0" /><input class="  checkbox section_field" id="helpdesk_ticket_custom_field_cf_sage_video_research_methods_sv_767774_7000149649" name="helpdesk_ticket[custom_field][cf_sage_video_research_methods_sv_767774]" type="checkbox" value="1" /> SAGE Research Methods Video Practical Research and Academic Skills Collection
            </label>
          </div> 
                </div>
                <div class="control-group ticket_section">
                    <div class="controls">
            <label class="checkbox ">
              <input name="helpdesk_ticket[custom_field][cf_sage_video_research_methods_data_sci_vs_767774]" type="hidden" value="0" /><input class="  checkbox section_field" id="helpdesk_ticket_custom_field_cf_sage_video_research_methods_data_sci_vs_767774_7000149649" name="helpdesk_ticket[custom_field][cf_sage_video_research_methods_data_sci_vs_767774]" type="checkbox" value="1" /> SAGE Research Methods Video Data Science, Big Data Analytics, and Digital Methods Collection
            </label>
          </div> 
                </div>
                <div class="control-group ticket_section">
                    <div class="controls">
            <label class="checkbox ">
              <input name="helpdesk_ticket[custom_field][cf_sage_video_research_methods_market_research_sv_767774]" type="hidden" value="0" /><input class="  checkbox section_field" id="helpdesk_ticket_custom_field_cf_sage_video_research_methods_market_research_sv_767774_7000149649" name="helpdesk_ticket[custom_field][cf_sage_video_research_methods_market_research_sv_767774]" type="checkbox" value="1" /> SAGE Video Research Methods Market Research
            </label>
          </div> 
                </div>
                <div class="control-group ticket_section">
                    <div class="controls">
            <label class="checkbox ">
              <input name="helpdesk_ticket[custom_field][cf_sage_knowledge_complete_books_and_reference_collection_sv_767774]" type="hidden" value="0" /><input class="  checkbox section_field" id="helpdesk_ticket_custom_field_cf_sage_knowledge_complete_books_and_reference_collection_sv_767774_7000149649" name="helpdesk_ticket[custom_field][cf_sage_knowledge_complete_books_and_reference_collection_sv_767774]" type="checkbox" value="1" /> SAGE Knowledge Complete Books and Reference Collection
            </label>
          </div> 
                </div>
                <div class="control-group ticket_section">
                    <div class="controls">
            <label class="checkbox ">
              <input name="helpdesk_ticket[custom_field][cf_other_sv_767774]" type="hidden" value="0" /><input class="  checkbox section_field" id="helpdesk_ticket_custom_field_cf_other_sv_767774_7000149649" name="helpdesk_ticket[custom_field][cf_other_sv_767774]" type="checkbox" value="1" /> Other - please specify below
            </label>
          </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_click_yes_if_you_want_us_to_let_your_faculty_know_about_the_trial_sv_767774-label " for="helpdesk_ticket_cf_click_yes_if_you_want_us_to_let_your_faculty_know_about_the_trial_sv_767774">Do you want us to let your faculty know about the access?</label>
            <div class="controls   ">
              <select class="  dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_click_yes_if_you_want_us_to_let_your_faculty_know_about_the_trial_sv_767774" name="helpdesk_ticket[custom_field][cf_click_yes_if_you_want_us_to_let_your_faculty_know_about_the_trial_sv_767774]"><option value="">...</option>
<option value="Yes" data-id="7000149823">Yes</option>
<option value="No" data-id="7000149824">No</option></select>
            </div> 
                </div>

<div class="control-group ticket_section">
                   <label class=" required control-label cf_your_name_hold_print_767774-label " for="helpdesk_ticket_cf_your_name_hold_print_767774">Your Name</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_your_name_hold_print_767774" name="helpdesk_ticket[custom_field][cf_your_name_hold_print_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_end_user_account_number_hold_767774-label " for="helpdesk_ticket_cf_end_user_account_number_hold_767774">End User Account Number</label>
            <div class="controls   ">
              <input class="  text section_field span12" id="helpdesk_ticket_custom_field_cf_end_user_account_number_hold_767774" name="helpdesk_ticket[custom_field][cf_end_user_account_number_hold_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_your_region_767774-label " for="helpdesk_ticket_cf_your_region_767774">Your Region</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_your_region_767774" name="helpdesk_ticket[custom_field][cf_your_region_767774]"><option value="">...</option>
<option value="North, Central and South America" data-id="7000151800">North, Central and South America</option>
<option value="Europe, Africa, Asia and Oceania" data-id="7000151801">Europe, Africa, Asia and Oceania</option></select>
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_institution_name_hold_767774-label " for="helpdesk_ticket_cf_institution_name_hold_767774">Institution Name</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_institution_name_hold_767774" name="helpdesk_ticket[custom_field][cf_institution_name_hold_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_delivery_address_hold_767774-label " for="helpdesk_ticket_cf_delivery_address_hold_767774">Delivery Address Associated With Your Account</label>
            <div class="controls   ">
              <textarea class=" required paragraph section_field span12" cols="40" id="helpdesk_ticket_custom_field_cf_delivery_address_hold_767774" name="helpdesk_ticket[custom_field][cf_delivery_address_hold_767774]" rows="6">
&lt/textarea&gt
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_instit_cust_set_up_online_access_767774-label " for="helpdesk_ticket_cf_instit_cust_set_up_online_access_767774">Institutional print journal customers are able to access journals that they subscribe to online for no additional cost. Do you require help setting this up? </label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_instit_cust_set_up_online_access_767774" name="helpdesk_ticket[custom_field][cf_instit_cust_set_up_online_access_767774]"><option value="">...</option>
<option value="Yes, please provide me with more details" data-id="7000151802">Yes, please provide me with more details</option>
<option value="No help required" data-id="7000151803">No help required</option></select>
            </div> 
                </div>

<div class="control-group ticket_section">
                   <label class=" required control-label cf_customer_name_it_767774-label " for="helpdesk_ticket_cf_customer_name_it_767774">Customer name</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_customer_name_it_767774" name="helpdesk_ticket[custom_field][cf_customer_name_it_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_customer_email_it_767774-label " for="helpdesk_ticket_cf_customer_email_it_767774">Customer email address</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_customer_email_it_767774" name="helpdesk_ticket[custom_field][cf_customer_email_it_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_customer_telephone_number_it_767774-label " for="helpdesk_ticket_cf_customer_telephone_number_it_767774">Customer telephone number</label>
            <div class="controls   ">
              <input class="  text section_field span12" id="helpdesk_ticket_custom_field_cf_customer_telephone_number_it_767774" name="helpdesk_ticket[custom_field][cf_customer_telephone_number_it_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_institution_name_it_767774-label " for="helpdesk_ticket_cf_institution_name_it_767774">Institution name</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_institution_name_it_767774" name="helpdesk_ticket[custom_field][cf_institution_name_it_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_product_it_767774-label " for="helpdesk_ticket_cf_product_it_767774">Which would you like help with?</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_product_it_767774" name="helpdesk_ticket[custom_field][cf_product_it_767774]"><option value="">...</option>
<option value="Vantage Integration" data-id="7000172875">Vantage Integration</option>
<option value="Vantage Content" data-id="7000172282">Vantage Content</option>
<option value="Vantage Platform" data-id="7000172876">Vantage Platform</option>
<option value="SAGE Website" data-id="7000172877">SAGE Website</option>
<option value="VitalSource/Redshelf" data-id="7000170490">VitalSource/Redshelf</option>
<option value="Public Speaking Plus" data-id="7000172878">Public Speaking Plus</option>
<option value="SAGE UK/Corwin" data-id="7000172080">SAGE UK/Corwin</option>
<option value="Other" data-id="7000170491">Other</option></select>
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_request_type_it_767774-label " for="helpdesk_ticket_cf_request_type_it_767774">Request type</label>
            <div class="controls nested_field  ">
              <select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_request_type_it_767774_7000169771" name="helpdesk_ticket[custom_field][cf_request_type_it_767774]"><option value="">...</option>
<option value="Cases (Integration)">Cases (Integration)</option>
<option value="Instructor Issue">Instructor Issue</option>
<option value="Training">Training</option>
<option value="Student Issue">Student Issue</option>
<option value="Other">Other</option></select><div class="level_2"><label class="required">Request detail</label><select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_request_detail_it_767774_7000169771" name="helpdesk_ticket[custom_field][cf_request_detail_it_767774]"><option value="">...</option>
</select></div><script type="text/javascript">
//<![CDATA[
jQuery('#helpdesk_ticket_custom_field_cf_request_type_it_767774_7000169771').nested_select_tag({"data_tree":[["Cases (Integration)","Cases (Integration)",[]],["Instructor Issue","Instructor Issue",[]],["Training","Training",[]],["Student Issue","Student Issue",[]],["Other","Other",[["Other","Other",[]]]]],"initValues":null,"disable_children":false,"include_blank":"...","selected":null,"pl_value_id":"7000169771","subcategory_id":"helpdesk_ticket_custom_field_cf_request_detail_it_767774_7000169771"});
//]]>
</script>
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_priority_it_767774-label " for="helpdesk_ticket_cf_priority_it_767774">Priority</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_priority_it_767774" name="helpdesk_ticket[custom_field][cf_priority_it_767774]"><option value="">...</option>
<option value="Low" data-id="7000170970">Low</option>
<option value="Medium" data-id="7000170971">Medium</option>
<option value="High" data-id="7000170972">High</option>
<option value="Urgent" data-id="7000170973">Urgent</option></select>
            </div> 
                </div>

<div class="control-group ticket_section">
                   <label class=" required control-label cf_customer_name_j_e_comp_767774-label " for="helpdesk_ticket_cf_customer_name_j_e_comp_767774">Your name</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_customer_name_j_e_comp_767774" name="helpdesk_ticket[custom_field][cf_customer_name_j_e_comp_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_customer_number_j_ecomp_767774-label " for="helpdesk_ticket_cf_customer_number_j_ecomp_767774">Your customer number (you can find this on the label sent with your journal)</label>
            <div class="controls   ">
              <input class="  number section_field span12" id="helpdesk_ticket_custom_field_cf_customer_number_j_ecomp_767774" name="helpdesk_ticket[custom_field][cf_customer_number_j_ecomp_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_country_region_767774-label " for="helpdesk_ticket_cf_country_region_767774">Your Region</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_country_region_767774" name="helpdesk_ticket[custom_field][cf_country_region_767774]"><option value="">...</option>
<option value="North, Central and South America" data-id="7000151788">North, Central and South America</option>
<option value="Europe, Africa, Asia and Oceania" data-id="7000151789">Europe, Africa, Asia and Oceania</option></select>
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_country_journ_e_comp_767774-label " for="helpdesk_ticket_cf_country_journ_e_comp_767774">Your Country</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_country_journ_e_comp_767774" name="helpdesk_ticket[custom_field][cf_country_journ_e_comp_767774]" size="30" type="text" />
            </div> 
                </div>

<div class="control-group ticket_section">
                   <label class=" required control-label cf_territory_ir_767774-label " for="helpdesk_ticket_cf_territory_ir_767774">Select Territory</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_territory_ir_767774" name="helpdesk_ticket[custom_field][cf_territory_ir_767774]"><option value="">...</option>
<option value="US" data-id="7000161107">US</option>
<option value="ROW" data-id="7000161108">ROW</option></select>
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_institution_ir_767774-label " for="helpdesk_ticket_cf_institution_ir_767774">Institution Name</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_institution_ir_767774" name="helpdesk_ticket[custom_field][cf_institution_ir_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_institution_address_ir_767774-label " for="helpdesk_ticket_cf_institution_address_ir_767774">Institution Address</label>
            <div class="controls   ">
              <textarea class=" required paragraph section_field span12" cols="40" id="helpdesk_ticket_custom_field_cf_institution_address_ir_767774" name="helpdesk_ticket[custom_field][cf_institution_address_ir_767774]" rows="6">
&lt/textarea&gt
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_bill_to_nameaddress_if_different_767774-label " for="helpdesk_ticket_cf_bill_to_nameaddress_if_different_767774">Bill to name/address, if different</label>
            <div class="controls   ">
              <textarea class="  paragraph section_field span12" cols="40" id="helpdesk_ticket_custom_field_cf_bill_to_nameaddress_if_different_767774" name="helpdesk_ticket[custom_field][cf_bill_to_nameaddress_if_different_767774]" rows="6">
&lt/textarea&gt
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_vat_number_ir_767774-label " for="helpdesk_ticket_cf_vat_number_ir_767774">VAT Number (if VAT exempt, please attach VAT Exemption Certificate)</label>
            <div class="controls   ">
              <input class="  text section_field span12" id="helpdesk_ticket_custom_field_cf_vat_number_ir_767774" name="helpdesk_ticket[custom_field][cf_vat_number_ir_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_customer_email_address_ir_767774-label " for="helpdesk_ticket_cf_customer_email_address_ir_767774">Customer Email Address</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_customer_email_address_ir_767774" name="helpdesk_ticket[custom_field][cf_customer_email_address_ir_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_po_number_ir_767774-label " for="helpdesk_ticket_cf_po_number_ir_767774">PO Number</label>
            <div class="controls   ">
              <input class="  text section_field span12" id="helpdesk_ticket_custom_field_cf_po_number_ir_767774" name="helpdesk_ticket[custom_field][cf_po_number_ir_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_products_with_isbn_or_ssin_and_price_net_767774-label " for="helpdesk_ticket_cf_products_with_isbn_or_ssin_and_price_net_767774">Product(s) with ISBN or SSIN and Price (net). For multiple products, you can also attach the list of titles and net prices. Use ‘Attach file’ at the bottom of the form.</label>
            <div class="controls   ">
              <textarea class=" required paragraph section_field span12" cols="40" id="helpdesk_ticket_custom_field_cf_products_with_isbn_or_ssin_and_price_net_767774" name="helpdesk_ticket[custom_field][cf_products_with_isbn_or_ssin_and_price_net_767774]" rows="6">
&lt/textarea&gt
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_start_date_ir_767774-label " for="helpdesk_ticket_cf_start_date_ir_767774">Start 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_start_date_ir_767774" name="helpdesk_ticket[custom_field][cf_start_date_ir_767774]" readonly="readonly" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_end_date_ir_767774-label " for="helpdesk_ticket_cf_end_date_ir_767774">End 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_end_date_ir_767774" name="helpdesk_ticket[custom_field][cf_end_date_ir_767774]" readonly="readonly" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_currency_ir_767774-label " for="helpdesk_ticket_cf_currency_ir_767774">Currency</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_currency_ir_767774" name="helpdesk_ticket[custom_field][cf_currency_ir_767774]"><option value="">...</option>
<option value="USD" data-id="7000161109">USD</option>
<option value="GBP" data-id="7000161110">GBP</option></select>
            </div> 
                </div>

<div class="control-group ticket_section">
                   <label class="  control-label cf_request_type_prm_is_767774-label " for="helpdesk_ticket_cf_request_type_prm_is_767774">Request Type - PRM IS</label>
            <div class="controls nested_field  ">
              <select class="  nested_field section_field" id="helpdesk_ticket_custom_field_cf_request_type_prm_is_767774_7000169272" name="helpdesk_ticket[custom_field][cf_request_type_prm_is_767774]"><option value="">...</option>
<option value="Status updates">Status updates</option>
<option value="Extension requests">Extension requests</option>
<option value="General query">General query</option>
<option value="Configuration change">Configuration change</option>
<option value="Troubleshooting">Troubleshooting</option>
<option value="Instructional">Instructional</option>
<option value="Ethics/Best Practice">Ethics/Best Practice</option>
<option value="Close No Action">Close No Action</option>
<option value="Launches &amp; Transfer">Launches &amp; Transfer</option>
<option value="Editorial Transitions">Editorial Transitions</option>
<option value="Demo">Demo</option></select><div class="level_2"><label class="">Subrequest Type - PRM IS</label><select class="  nested_field section_field" id="helpdesk_ticket_custom_field_cf_subrequest_type_prm_is_767774_7000169272" name="helpdesk_ticket[custom_field][cf_subrequest_type_prm_is_767774]"><option value="">...</option>
</select></div><script type="text/javascript">
//<![CDATA[
jQuery('#helpdesk_ticket_custom_field_cf_request_type_prm_is_767774_7000169272').nested_select_tag({"data_tree":[["Status updates","Status updates",[["Manuscript","Manuscript",[]],["Special Collection/Issue","Special Collection/Issue",[]],["Other","Other",[]]]],["Extension requests","Extension requests",[["Revised submission deadline","Revised submission deadline",[]],["Review deadline","Review deadline",[]],["Other","Other",[]]]],["General query","General query",[["Special Collection/Issue","Special Collection/Issue",[]],["Time to first decision","Time to first decision",[]],["Time to final decision","Time to final decision",[]],["Production process","Production process",[]],["Submission guidelines","Submission guidelines",[]],["Other","Other",[]]]],["Configuration change","Configuration change",[["Manuscript submission","Manuscript submission",[]],["Workflow change","Workflow change",[]],["Task settings","Task settings",[]],["Task scoresheet","Task scoresheet",[]],["Atrributes","Atrributes",[]],["Add-on","Add-on",[]],["Other","Other",[]]]],["Troubleshooting","Troubleshooting",[["Email template","Email template",[]],["Reporting","Reporting",[]],["Manuscript export","Manuscript export",[]],["Account information","Account information",[]],["Manuscript submission","Manuscript submission",[]],["Contributor form","Contributor form",[]],["Other","Other",[]]]],["Instructional","Instructional",[["Email template","Email template",[]],["Reporting","Reporting",[]],["Account information","Account information",[]],["Granting extensions","Granting extensions",[]],["Editing author-supplied data","Editing author-supplied data",[]],["File management","File management",[]],["Task functionality","Task functionality",[]],["Other","Other",[]]]],["Ethics/Best Practice","Ethics/Best Practice",[]],["Close No Action","Close No Action",[]],["Launches & Transfer","Launches & Transfer",[]],["Editorial Transitions","Editorial Transitions",[]],["Demo","Demo",[]]],"initValues":null,"disable_children":false,"include_blank":"...","selected":null,"pl_value_id":"7000169272","subcategory_id":"helpdesk_ticket_custom_field_cf_subrequest_type_prm_is_767774_7000169272"});
//]]>
</script>
            </div> 
                </div>

<div class="control-group ticket_section">
                   <label class=" required control-label cf_priority_pm_767774-label " for="helpdesk_ticket_cf_priority_pm_767774">Priority</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_priority_pm_767774" name="helpdesk_ticket[custom_field][cf_priority_pm_767774]"><option value="">...</option>
<option value="Urgent" data-id="7000128675">Urgent</option>
<option value="High" data-id="7000128676">High</option>
<option value="Medium" data-id="7000128677">Medium</option>
<option value="Low" data-id="7000128678">Low</option></select>
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_request_type_po_767774-label " for="helpdesk_ticket_cf_request_type_po_767774">Category</label>
            <div class="controls nested_field  ">
              <select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_request_type_po_767774_7000128673" name="helpdesk_ticket[custom_field][cf_request_type_po_767774]"><option value="">...</option>
<option value="Status">Status</option>
<option value="Price">Price</option>
<option value="Add digital products">Add digital products</option>
<option value="Gratis to">Gratis to</option>
<option value="Out of print">Out of print</option>
<option value="Other">Other</option></select><div class="level_2"><label class="required">Subcategory </label><select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_request_subtype_po_767774_7000128673" name="helpdesk_ticket[custom_field][cf_request_subtype_po_767774]"><option value="">...</option>
</select></div><script type="text/javascript">
//<![CDATA[
jQuery('#helpdesk_ticket_custom_field_cf_request_type_po_767774_7000128673').nested_select_tag({"data_tree":[["Status","Status",[["NYP WBO","NYP WBO",[]],["Live","Live",[]],["Terminated","Terminated",[]]]],["Price","Price",[]],["Add digital products","Add digital products",[]],["Gratis to","Gratis to",[["Yes","Yes",[]],["No","No",[]]]],["Out of print","Out of print",[]],["Other","Other",[]]],"initValues":null,"disable_children":false,"include_blank":"...","selected":null,"pl_value_id":"7000128673","subcategory_id":"helpdesk_ticket_custom_field_cf_request_subtype_po_767774_7000128673"});
//]]>
</script>
            </div> 
                </div>
                <div class="control-group ticket_section">
                    <div class="controls">
            <label class="checkbox ">
              <input name="helpdesk_ticket[custom_field][cf_out_of_print_selections_767774]" type="hidden" value="0" /><input class="  checkbox section_field" id="helpdesk_ticket_custom_field_cf_out_of_print_selections_767774_7000128673" name="helpdesk_ticket[custom_field][cf_out_of_print_selections_767774]" type="checkbox" value="1" /> Hardback
            </label>
          </div> 
                </div>
                <div class="control-group ticket_section">
                    <div class="controls">
            <label class="checkbox ">
              <input name="helpdesk_ticket[custom_field][cf_paperback_po_767774]" type="hidden" value="0" /><input class="  checkbox section_field" id="helpdesk_ticket_custom_field_cf_paperback_po_767774_7000128673" name="helpdesk_ticket[custom_field][cf_paperback_po_767774]" type="checkbox" value="1" /> Paperback
            </label>
          </div> 
                </div>
                <div class="control-group ticket_section">
                    <div class="controls">
            <label class="checkbox ">
              <input name="helpdesk_ticket[custom_field][cf_epub2_po_767774]" type="hidden" value="0" /><input class="  checkbox section_field" id="helpdesk_ticket_custom_field_cf_epub2_po_767774_7000128673" name="helpdesk_ticket[custom_field][cf_epub2_po_767774]" type="checkbox" value="1" /> EPub2
            </label>
          </div> 
                </div>
                <div class="control-group ticket_section">
                    <div class="controls">
            <label class="checkbox ">
              <input name="helpdesk_ticket[custom_field][cf_epub_3_po_767774]" type="hidden" value="0" /><input class="  checkbox section_field" id="helpdesk_ticket_custom_field_cf_epub_3_po_767774_7000128673" name="helpdesk_ticket[custom_field][cf_epub_3_po_767774]" type="checkbox" value="1" /> EPub 3
            </label>
          </div> 
                </div>
                <div class="control-group ticket_section">
                    <div class="controls">
            <label class="checkbox ">
              <input name="helpdesk_ticket[custom_field][cf_web_pdf_po_767774]" type="hidden" value="0" /><input class="  checkbox section_field" id="helpdesk_ticket_custom_field_cf_web_pdf_po_767774_7000128673" name="helpdesk_ticket[custom_field][cf_web_pdf_po_767774]" type="checkbox" value="1" /> Web PDF
            </label>
          </div> 
                </div>
                <div class="control-group ticket_section">
                    <div class="controls">
            <label class="checkbox ">
              <input name="helpdesk_ticket[custom_field][cf_ieb_po_767774]" type="hidden" value="0" /><input class="  checkbox section_field" id="helpdesk_ticket_custom_field_cf_ieb_po_767774_7000128673" name="helpdesk_ticket[custom_field][cf_ieb_po_767774]" type="checkbox" value="1" /> IEB
            </label>
          </div> 
                </div>
                <div class="control-group ticket_section">
                    <div class="controls">
            <label class="checkbox ">
              <input name="helpdesk_ticket[custom_field][cf_loose_leaf_po_767774]" type="hidden" value="0" /><input class="  checkbox section_field" id="helpdesk_ticket_custom_field_cf_loose_leaf_po_767774_7000128673" name="helpdesk_ticket[custom_field][cf_loose_leaf_po_767774]" type="checkbox" value="1" /> Loose leaf
            </label>
          </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_requester_department_po_767774-label " for="helpdesk_ticket_cf_requester_department_po_767774">Requester department</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_requester_department_po_767774" name="helpdesk_ticket[custom_field][cf_requester_department_po_767774]"><option value="">...</option>
<option value="Editorial" data-id="7000128541">Editorial</option>
<option value="Marketing" data-id="7000128542">Marketing</option>
<option value="Sales" data-id="7000128674">Sales</option></select>
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_region_po_767774-label " for="helpdesk_ticket_cf_region_po_767774">Region</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_region_po_767774" name="helpdesk_ticket[custom_field][cf_region_po_767774]"><option value="">...</option>
<option value="UK" data-id="7000127957">UK</option>
<option value="US" data-id="7000127958">US</option>
<option value="India" data-id="7000127959">India</option></select>
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_pillar_po_767774-label " for="helpdesk_ticket_cf_pillar_po_767774">Pillar</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_pillar_po_767774" name="helpdesk_ticket[custom_field][cf_pillar_po_767774]"><option value="">...</option>
<option value="Teaching" data-id="7000128543">Teaching</option>
<option value="Learning" data-id="7000128544">Learning</option></select>
            </div> 
                </div>

<div class="control-group ticket_section">
                   <label class=" required control-label cf_customer_name_pt_767774-label " for="helpdesk_ticket_cf_customer_name_pt_767774">Customer Name</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_customer_name_pt_767774" name="helpdesk_ticket[custom_field][cf_customer_name_pt_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_customer_email_pt_767774-label " for="helpdesk_ticket_cf_customer_email_pt_767774">Customer Email</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_customer_email_pt_767774" name="helpdesk_ticket[custom_field][cf_customer_email_pt_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_trial_start_date_pt_767774-label " for="helpdesk_ticket_cf_trial_start_date_pt_767774">Complimentary Access Start 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_trial_start_date_pt_767774" name="helpdesk_ticket[custom_field][cf_trial_start_date_pt_767774]" readonly="readonly" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_trial_end_date_pt_767774-label " for="helpdesk_ticket_cf_trial_end_date_pt_767774">Complimentary Access End 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_trial_end_date_pt_767774" name="helpdesk_ticket[custom_field][cf_trial_end_date_pt_767774]" readonly="readonly" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_products_pt_767774-label " for="helpdesk_ticket_cf_products_pt_767774">Product(s)</label>
            <div class="controls   ">
              <textarea class=" required paragraph section_field span12" cols="40" id="helpdesk_ticket_custom_field_cf_products_pt_767774" name="helpdesk_ticket[custom_field][cf_products_pt_767774]" rows="6">
&lt/textarea&gt
            </div> 
                </div>

<div class="control-group ticket_section">
                   <label class=" required control-label cf_where_are_you_located_pp_767774-label " for="helpdesk_ticket_cf_where_are_you_located_pp_767774">Where are you located?</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_where_are_you_located_pp_767774" name="helpdesk_ticket[custom_field][cf_where_are_you_located_pp_767774]"><option value="">...</option>
<option value="North, Central or South America" data-id="7000147740">North, Central or South America</option>
<option value="Europe, Africa, Asia or Oceania" data-id="7000147741">Europe, Africa, Asia or Oceania</option></select>
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_customer_type_sagpeubcom_767774-label " for="helpdesk_ticket_cf_customer_type_sagpeubcom_767774">Which customer type best describes you?</label>
            <div class="controls nested_field  ">
              <select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_customer_type_sagpeubcom_767774_7000170519" name="helpdesk_ticket[custom_field][cf_customer_type_sagpeubcom_767774]"><option value="">...</option>
<option value="Librarian">Librarian</option>
<option value="Student">Student</option>
<option value="Instructor">Instructor</option>
<option value="Researcher">Researcher</option>
<option value="Author or Editor">Author or Editor</option>
<option value="Society Member">Society Member</option>
<option value="Other">Other</option></select><div class="level_2"><label class="required">Which product is this regarding?</label><select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_product_sagepubcom_767774_7000170519" name="helpdesk_ticket[custom_field][cf_product_sagepubcom_767774]"><option value="">...</option>
</select></div><div class="level_3"><label class="required">What can we help you with?</label><select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_reason_of_contact_sagepubcom_767774_7000170519" name="helpdesk_ticket[custom_field][cf_reason_of_contact_sagepubcom_767774]"><option value="">...</option>
</select></div><script type="text/javascript">
//<![CDATA[
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</select></div><script type="text/javascript">
//<![CDATA[
jQuery('#helpdesk_ticket_custom_field_reason_of_contact_767774_7000072970').nested_select_tag({"data_tree":[["Tier 1","Tier 1",[["Password reset","Password reset",[]],["add/remove admin","add/remove admin",[]],["verify account","verify account",[]],["update authentication - simple","update authentication - simple",[]],["provide KBART","provide KBART",[]],["provide MARC","provide MARC",[]],["provide usage report","provide usage report",[]],["resolve IP block","resolve IP block",[]],["CAPTCHA issue","CAPTCHA issue",[]],["platform feedback","platform feedback",[]],["others","others",[]]]],["Tier 2","Tier 2",[["access claim - subs needed processing","access claim - subs needed processing",[]],["access claim - missing authentication method","access claim - missing authentication method",[]],["IP updates - clash","IP updates - clash",[]],["E-reader","E-reader",[]],["EzProxy problems","EzProxy problems",[]],["Reviewer access","Reviewer access",[]],["create token URLs","create token URLs",[]],["Society access - non TPS","Society access - non TPS",[]],["PPV","PPV",[]],["functionality questions","functionality questions",[]],["others","others",[]]]],["Tier 3","Tier 3",[["Atypon - unexpected behaviour","Atypon - unexpected behaviour",[]],["Atypon - bug / release","Atypon - bug / release",[]],["Atypon - platform wide issue","Atypon - platform wide issue",[]],["Atypon - IP block","Atypon - IP block",[]],["PubTech - unexpected behaviour","PubTech - unexpected behaviour",[]],["PubTech - bug / release","PubTech - bug / release",[]],["PubTech - platform wieder issue","PubTech - platform wieder issue",[]],["ProdTech - missing/incorrect content","ProdTech - missing/incorrect content",[]],["ProdTech - DOIs","ProdTech - DOIs",[]],["ProdTech - ERM issues","ProdTech - ERM issues",[]],["ProdTech - KBART","ProdTech - KBART",[]],["Circ - resend request","Circ - resend request",[]],["Circ - product set up issues","Circ - product set up issues",[]],["Others","Others",[]]]]],"initValues":null,"disable_children":false,"include_blank":"...","selected":null,"pl_value_id":"7000072970","subcategory_id":"helpdesk_ticket_custom_field_action_767774_7000072970"});
//]]>
</script>
            </div> 
                </div>

<div class="control-group ticket_section">
                   <label class=" required control-label cf_batch_tele_767774-label " for="helpdesk_ticket_cf_batch_tele_767774">Batch</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_batch_tele_767774" name="helpdesk_ticket[custom_field][cf_batch_tele_767774]"><option value="">...</option>
<option value="1" data-id="7000166164">1</option>
<option value="2" data-id="7000166165">2</option>
<option value="3" data-id="7000166166">3</option>
<option value="4" data-id="7000166167">4</option></select>
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_transfer_title_if_applicable_tele_767774-label " for="helpdesk_ticket_cf_transfer_title_if_applicable_tele_767774">If this is a transfer title form, select the title. If it is a regular telerenewals form, select N/A</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_transfer_title_if_applicable_tele_767774" name="helpdesk_ticket[custom_field][cf_transfer_title_if_applicable_tele_767774]"><option value="">...</option>
<option value="Australasian Marketing Journal" data-id="7000171226">Australasian Marketing Journal</option>
<option value="City &amp; Community" data-id="7000171227">City &amp; Community</option>
<option value="European Journal of Personality" data-id="7000171228">European Journal of Personality</option>
<option value="N/A" data-id="7000171229">N/A</option></select>
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_customer_name_767774-label " for="helpdesk_ticket_cf_customer_name_767774">Customer or Organization Name</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_customer_name_767774" name="helpdesk_ticket[custom_field][cf_customer_name_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_a2r_account_number_tele_767774-label " for="helpdesk_ticket_cf_a2r_account_number_tele_767774">A2R Account Number</label>
            <div class="controls   ">
              <input class=" required number section_field span12" id="helpdesk_ticket_custom_field_cf_a2r_account_number_tele_767774" name="helpdesk_ticket[custom_field][cf_a2r_account_number_tele_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_customer_region_tele_767774-label " for="helpdesk_ticket_cf_customer_region_tele_767774">Customer Region</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_customer_region_tele_767774" name="helpdesk_ticket[custom_field][cf_customer_region_tele_767774]"><option value="">...</option>
<option value="North, Central and South America" data-id="7000151794">North, Central and South America</option>
<option value="Europe, Africa, Asia and Oceania" data-id="7000151795">Europe, Africa, Asia and Oceania</option></select>
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_status_applies_to_all_or_some_tele_767774-label " for="helpdesk_ticket_cf_status_applies_to_all_or_some_tele_767774">Status applies to</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_status_applies_to_all_or_some_tele_767774" name="helpdesk_ticket[custom_field][cf_status_applies_to_all_or_some_tele_767774]"><option value="">...</option>
<option value="100% of their titles" data-id="7000166162">100% of their titles</option>
<option value="Roughly 75% of their titles" data-id="7000166163">Roughly 75% of their titles</option>
<option value="Roughly 50% of their titles" data-id="7000166446">Roughly 50% of their titles</option>
<option value="Roughly 25% of their titles" data-id="7000166447">Roughly 25% of their titles</option></select>
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_subscription_status_tele371356_767774-label " for="helpdesk_ticket_cf_subscription_status_tele371356_767774">Subscription Status </label>
            <div class="controls nested_field  ">
              <select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_subscription_status_tele371356_767774_7000149487" name="helpdesk_ticket[custom_field][cf_subscription_status_tele371356_767774]"><option value="">...</option>
<option value="Cancelled">Cancelled</option>
<option value="Pending">Pending</option>
<option value="Already Renewed">Already Renewed</option>
<option value="Would like to renew">Would like to renew</option>
<option value="Unknown/Not Specified">Unknown/Not Specified</option></select><div class="level_2"><label class="required">Subscription Status Detail</label><select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_subscription_status_detail_tele_767774_7000149487" name="helpdesk_ticket[custom_field][cf_subscription_status_detail_tele_767774]"><option value="">...</option>
</select></div><div class="level_3"><label class="required">Subscription Status Further Detail</label><select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_subscription_status_further_detail_as_determined_by_accucomms_tele_767774_7000149487" name="helpdesk_ticket[custom_field][cf_subscription_status_further_detail_as_determined_by_accucomms_tele_767774]"><option value="">...</option>
</select></div><script type="text/javascript">
//<![CDATA[
jQuery('#helpdesk_ticket_custom_field_cf_subscription_status_tele371356_767774_7000149487').nested_select_tag({"data_tree":[["Cancelled","Cancelled",[["Upgraded to package/subject collection","Upgraded to package/subject collection",[]],["Budget","Budget",[["Standard budget cut","Standard budget cut"],["Covid related budget cut","Covid related budget cut"]]],["Price","Price",[]],["Low usage title(s)","Low usage title(s)",[]],["Other - add detail to free text field","Other - add detail to free text field",[]]]],["Pending","Pending",[["Delayed decision making - add detail to free text field","Delayed decision making - add detail to free text field",[]],["Not sure","Not sure",[]],["Will be renewing","Will be renewing",[]]]],["Already Renewed","Already Renewed",[]],["Would like to renew","Would like to renew",[]],["Unknown/Not Specified","Unknown/Not Specified",[]]],"initValues":null,"disable_children":false,"include_blank":"...","selected":null,"pl_value_id":"7000149487","subcategory_id":"helpdesk_ticket_custom_field_cf_subscription_status_detail_tele_767774_7000149487","item_id":"helpdesk_ticket_custom_field_cf_subscription_status_further_detail_as_determined_by_accucomms_tele_767774_7000149487"});
//]]>
</script>
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_if_cancelled_for_other_reason_brief_description_here_per_accucomms_767774-label " for="helpdesk_ticket_cf_if_cancelled_for_other_reason_brief_description_here_per_accucomms_767774">If subscription status is 'Cancelled - Other' or 'Pending - Delayed', please provide detail here</label>
            <div class="controls   ">
              <input class="  text section_field span12" id="helpdesk_ticket_custom_field_cf_if_cancelled_for_other_reason_brief_description_here_per_accucomms_767774" name="helpdesk_ticket[custom_field][cf_if_cancelled_for_other_reason_brief_description_here_per_accucomms_767774]" size="30" type="text" />
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class=" required control-label cf_next_action_required_as_determined_by_accucoms_tele_767774-label " for="helpdesk_ticket_cf_next_action_required_as_determined_by_accucoms_tele_767774">Next action required</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field" id="helpdesk_ticket_custom_field_cf_next_action_required_as_determined_by_accucoms_tele_767774" name="helpdesk_ticket[custom_field][cf_next_action_required_as_determined_by_accucoms_tele_767774]"><option value="">...</option>
<option value="Send invoice/quote" data-id="7000162831">Send invoice/quote</option>
<option value="Remove from calling list" data-id="7000162832">Remove from calling list</option>
<option value="Contact customer as requested - see notes" data-id="7000162833">Contact customer as requested - see notes</option>
<option value="No further action required" data-id="7000166773">No further action required</option>
<option value="Other - provide detail in free text field" data-id="7000162834">Other - provide detail in free text field</option></select>
            </div> 
                </div>
                <div class="control-group ticket_section">
                   <label class="  control-label cf_if_next_action_is_other_brief_description_as_determined_by_accucomms_telel_767774-label " for="helpdesk_ticket_cf_if_next_action_is_other_brief_description_as_determined_by_accucomms_telel_767774">If Next Action is 'Other', please provide a brief description</label>
            <div class="controls   ">
              <input class="  text section_field span12" id="helpdesk_ticket_custom_field_cf_if_next_action_is_other_brief_description_as_determined_by_accucomms_telel_767774" name="helpdesk_ticket[custom_field][cf_if_next_action_is_other_brief_description_as_determined_by_accucomms_telel_767774]" size="30" type="text" />
            </div> 
                </div>

<div class="control-group ticket_section">
                   <label class=" required control-label cf_reason_of_contact_us_cs_767774-label " for="helpdesk_ticket_cf_reason_of_contact_us_cs_767774">Reason for contacting</label>
            <div class="controls nested_field  ">
              <select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_reason_of_contact_us_cs_767774_7000103961" name="helpdesk_ticket[custom_field][cf_reason_of_contact_us_cs_767774]"><option value="">...</option>
<option value="Orders">Orders</option>
<option value="Price and Availability">Price and Availability</option>
<option value="Journals Claims">Journals Claims</option>
<option value="Returns/Credit Memo Inquiry">Returns/Credit Memo Inquiry</option>
<option value="Account Maintenance Requests">Account Maintenance Requests</option>
<option value="Author Queries">Author Queries</option>
<option value="General Inquiry">General Inquiry</option>
<option value="Forward No Action">Forward No Action</option>
<option value="Payment Portal">Payment Portal</option>
<option value="How to place an order">How to place an order</option></select><div class="level_2"><label class="required">Subgroup</label><select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_subcategory_767774_7000103961" name="helpdesk_ticket[custom_field][cf_subcategory_767774]"><option value="">...</option>
</select></div><script type="text/javascript">
//<![CDATA[
jQuery('#helpdesk_ticket_custom_field_cf_reason_of_contact_us_cs_767774_7000103961').nested_select_tag({"data_tree":[["Orders","Orders",[["Credit Card","Credit Card",[]],["POs/Bill To","POs/Bill To",[]],["Corwin Comps","Corwin Comps",[]],["Inspection Copies","Inspection Copies",[]],["In-House","In-House",[]],["Web Order","Web Order",[]],["Cancellation","Cancellation",[]],["Convention","Convention",[]],["Author","Author",[]]]],["Price and Availability","Price and Availability",[]],["Journals Claims","Journals Claims",[["Request","Request",[]],["Inquiry","Inquiry",[]]]],["Returns/Credit Memo Inquiry","Returns/Credit Memo Inquiry",[]],["Account Maintenance Requests","Account Maintenance Requests",[["Changes/Updates/New","Changes/Updates/New",[]],["Other","Other",[]]]],["Author Queries","Author Queries",[["Manuscript Submissions","Manuscript Submissions",[]],["Other","Other",[]]]],["General Inquiry","General Inquiry",[["Order Status Request","Order Status Request",[]],["Order Follow Up","Order Follow Up",[]],["Order Maintenance","Order Maintenance",[]],["Invoice Request","Invoice Request",[]],["Quote/Price &amp; Availability","Quote/Price &amp; Availability",[]],["Manuscript submission","Manuscript submission",[]],["Other","Other",[]]]],["Forward No Action","Forward No Action",[["Account Support Related","Account Support Related",[]],["Credit –Credit Memo, Payments, Statements, Credit Manager Inquiries","Credit –Credit Memo, Payments, Statements, Credit Manager Inquiries",[]],["Claims – Returns, Damages, Shortages","Claims – Returns, Damages, Shortages",[]],["Professor Inquiry","Professor Inquiry",[]],["Technical Issues","Technical Issues",[]],["Remove from Mailing List","Remove from Mailing List",[]],["Institution Not Listed","Institution Not Listed",[]],["Pay to Publish Inquiry","Pay to Publish Inquiry",[]],["Sales Related","Sales Related",[]],["Other","Other",[]]]],["Payment Portal","Payment Portal",[["Registration Issue","Registration Issue",[]],["Email Change","Email Change",[]],["Payment Issue","Payment Issue",[]],["Multiple accounts in A2R","Multiple accounts in A2R",[]],["Quotation","Quotation",[]],["Other","Other",[]]]],["How to place an order","How to place an order",[]]],"initValues":null,"disable_children":false,"include_blank":"...","selected":null,"pl_value_id":"7000103961","subcategory_id":"helpdesk_ticket_custom_field_cf_subcategory_767774_7000103961"});
//]]>
</script>
            </div> 
                </div>

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