Golden Limousine, Inc. Widget

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<div class="control-group ticket_section">
                 <label class=" required control-label cf_date_762997-label " for="helpdesk_ticket_cf_date_762997">Date</label>
            <div class="controls  support-date-field ">
              <input class=" required date section_field datepicker_popover" data-date-format="M d, yy" data-show-image="true" id="helpdesk_ticket_custom_field_cf_date_762997" name="helpdesk_ticket[custom_field][cf_date_762997]" readonly="readonly" type="text" />
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class=" required control-label pick_up_time_762997-label " for="helpdesk_ticket_pick_up_time_762997">Pick up time</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field dynamic_sections" id="helpdesk_ticket_custom_field_pick_up_time_762997" name="helpdesk_ticket[custom_field][pick_up_time_762997]"><option value="">...</option>
<option value="1:00" data-id="35000396053">1:00</option>
<option value="1:15" data-id="35000396054">1:15</option>
<option value="1:30" data-id="35000396055">1:30</option>
<option value="1:45" data-id="35000396056">1:45</option>
<option value="2:00" data-id="35000396057">2:00</option>
<option value="2:15" data-id="35000396058">2:15</option>
<option value="2:15" data-id="35000396059">2:15</option>
<option value="2:45" data-id="35000396060">2:45</option>
<option value="3:00" data-id="35000396061">3:00</option>
<option value="3:15" data-id="35000396062">3:15</option>
<option value="3:30" data-id="35000396063">3:30</option>
<option value="3:45" data-id="35000396064">3:45</option>
<option value="4:00" data-id="35000396065">4:00</option>
<option value="4:15" data-id="35000396066">4:15</option>
<option value="4:30" data-id="35000396067">4:30</option>
<option value="4:45" data-id="35000396068">4:45</option>
<option value="5:00" data-id="35000396069">5:00</option>
<option value="5:15" data-id="35000396070">5:15</option>
<option value="5:30" data-id="35000396071">5:30</option>
<option value="5:45" data-id="35000396072">5:45</option>
<option value="6:00" data-id="35000396073">6:00</option>
<option value="6:15" data-id="35000396074">6:15</option>
<option value="6:30" data-id="35000396075">6:30</option>
<option value="6:45" data-id="35000396076">6:45</option>
<option value="7:00" data-id="35000396077">7:00</option>
<option value="7:15" data-id="35000396078">7:15</option>
<option value="7:30" data-id="35000396079">7:30</option>
<option value="7:45" data-id="35000396080">7:45</option>
<option value="8:00" data-id="35000396081">8:00</option>
<option value="8:15" data-id="35000396082">8:15</option>
<option value="8:30" data-id="35000396083">8:30</option>
<option value="8:45" data-id="35000396084">8:45</option>
<option value="9:00" data-id="35000396085">9:00</option>
<option value="9:15" data-id="35000396086">9:15</option>
<option value="9:30" data-id="35000396087">9:30</option>
<option value="9:45" data-id="35000396088">9:45</option>
<option value="10:00" data-id="35000396089">10:00</option>
<option value="10:15" data-id="35000396090">10:15</option>
<option value="10:30" data-id="35000396091">10:30</option>
<option value="10:45" data-id="35000396092">10:45</option>
<option value="11:00" data-id="35000396093">11:00</option>
<option value="11:15" data-id="35000396094">11:15</option>
<option value="11:30" data-id="35000396095">11:30</option>
<option value="11:45" data-id="35000396096">11:45</option>
<option value="12:00" data-id="35000396097">12:00</option>
<option value="12:15" data-id="35000396098">12:15</option>
<option value="12:30" data-id="35000396099">12:30</option>
<option value="12:45" data-id="35000396100">12:45</option></select>
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class=" required control-label cf_ampm_762997-label " for="helpdesk_ticket_cf_ampm_762997">AM/PM</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field dynamic_sections" id="helpdesk_ticket_custom_field_cf_ampm_762997" name="helpdesk_ticket[custom_field][cf_ampm_762997]"><option value="">...</option>
<option value="AM" data-id="35000546690">AM</option>
<option value="PM" data-id="35000546691">PM</option></select>
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class=" required control-label number_of_passengers_762997-label " for="helpdesk_ticket_number_of_passengers_762997">Number of passengers</label>
            <div class="controls   ">
              <input class=" required number section_field span12" id="helpdesk_ticket_custom_field_number_of_passengers_762997" name="helpdesk_ticket[custom_field][number_of_passengers_762997]" size="30" type="text" />
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class=" required control-label passenger_name_762997-label " for="helpdesk_ticket_passenger_name_762997">Passenger Name</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_passenger_name_762997" name="helpdesk_ticket[custom_field][passenger_name_762997]" size="30" type="text" />
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class=" required control-label passenger_phone_number_762997-label " for="helpdesk_ticket_passenger_phone_number_762997">Passenger mobile #</label>
            <div class="controls   ">
              <input class=" required number section_field span12" id="helpdesk_ticket_custom_field_passenger_phone_number_762997" name="helpdesk_ticket[custom_field][passenger_phone_number_762997]" size="30" type="text" />
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class=" required control-label vehicle_type_762997-label " for="helpdesk_ticket_vehicle_type_762997">Vehicle type</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field dynamic_sections" id="helpdesk_ticket_custom_field_vehicle_type_762997" name="helpdesk_ticket[custom_field][vehicle_type_762997]"><option value="">...</option>
<option value="Sedan (1-3 passengers)" data-id="35000382674">Sedan (1-3 passengers)</option>
<option value="SUV (1-6 passengers)" data-id="35000382675">SUV (1-6 passengers)</option>
<option value="Van (1-9 passengers)" data-id="35000382676">Van (1-9 passengers)</option>
<option value="Sprinter Van (1-15 passengers)" data-id="35000382677">Sprinter Van (1-15 passengers)</option>
<option value="Sprinter Limo (1-12 passengers)" data-id="35000382678">Sprinter Limo (1-12 passengers)</option>
<option value="Stretch Limo (1-6 passengers)" data-id="35000382679">Stretch Limo (1-6 passengers)</option>
<option value="Mini Bus Small (1-24 passengers)" data-id="35000382680">Mini Bus Small (1-24 passengers)</option>
<option value="Mini Bus Medium (1-28 passengers)" data-id="35000382681">Mini Bus Medium (1-28 passengers)</option>
<option value="Mini Bus Large (1-34 passengers)" data-id="35000382682">Mini Bus Large (1-34 passengers)</option>
<option value="Motor Coach (1-56 passengers)" data-id="35000382683">Motor Coach (1-56 passengers)</option></select>
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class=" required control-label pick_up_location_762997-label " for="helpdesk_ticket_pick_up_location_762997">Pick up location</label>
            <div class="controls   ">
              <textarea class=" required paragraph section_field span12" cols="40" id="helpdesk_ticket_custom_field_pick_up_location_762997" name="helpdesk_ticket[custom_field][pick_up_location_762997]" rows="6">
</textarea>
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class="  control-label additional_stops_762997-label " for="helpdesk_ticket_additional_stops_762997">Additional stops or itinerary info</label>
            <div class="controls   ">
              <textarea class="  paragraph section_field span12" cols="40" id="helpdesk_ticket_custom_field_additional_stops_762997" name="helpdesk_ticket[custom_field][additional_stops_762997]" rows="6">
</textarea>
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class=" required control-label drop_off_location_762997-label " for="helpdesk_ticket_drop_off_location_762997">Drop off location</label>
            <div class="controls   ">
              <textarea class=" required paragraph section_field span12" cols="40" id="helpdesk_ticket_custom_field_drop_off_location_762997" name="helpdesk_ticket[custom_field][drop_off_location_762997]" rows="6">
</textarea>
            </div> 
                </div>

<div class="control-group ticket_section">
                 <label class=" required control-label cf_date_762997-label " for="helpdesk_ticket_cf_date_762997">Date</label>
            <div class="controls  support-date-field ">
              <input class=" required date section_field datepicker_popover" data-date-format="M d, yy" data-show-image="true" id="helpdesk_ticket_custom_field_cf_date_762997" name="helpdesk_ticket[custom_field][cf_date_762997]" readonly="readonly" type="text" />
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class=" required control-label pick_up_time_762997-label " for="helpdesk_ticket_pick_up_time_762997">Pick up time</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field dynamic_sections" id="helpdesk_ticket_custom_field_pick_up_time_762997" name="helpdesk_ticket[custom_field][pick_up_time_762997]"><option value="">...</option>
<option value="1:00" data-id="35000396053">1:00</option>
<option value="1:15" data-id="35000396054">1:15</option>
<option value="1:30" data-id="35000396055">1:30</option>
<option value="1:45" data-id="35000396056">1:45</option>
<option value="2:00" data-id="35000396057">2:00</option>
<option value="2:15" data-id="35000396058">2:15</option>
<option value="2:15" data-id="35000396059">2:15</option>
<option value="2:45" data-id="35000396060">2:45</option>
<option value="3:00" data-id="35000396061">3:00</option>
<option value="3:15" data-id="35000396062">3:15</option>
<option value="3:30" data-id="35000396063">3:30</option>
<option value="3:45" data-id="35000396064">3:45</option>
<option value="4:00" data-id="35000396065">4:00</option>
<option value="4:15" data-id="35000396066">4:15</option>
<option value="4:30" data-id="35000396067">4:30</option>
<option value="4:45" data-id="35000396068">4:45</option>
<option value="5:00" data-id="35000396069">5:00</option>
<option value="5:15" data-id="35000396070">5:15</option>
<option value="5:30" data-id="35000396071">5:30</option>
<option value="5:45" data-id="35000396072">5:45</option>
<option value="6:00" data-id="35000396073">6:00</option>
<option value="6:15" data-id="35000396074">6:15</option>
<option value="6:30" data-id="35000396075">6:30</option>
<option value="6:45" data-id="35000396076">6:45</option>
<option value="7:00" data-id="35000396077">7:00</option>
<option value="7:15" data-id="35000396078">7:15</option>
<option value="7:30" data-id="35000396079">7:30</option>
<option value="7:45" data-id="35000396080">7:45</option>
<option value="8:00" data-id="35000396081">8:00</option>
<option value="8:15" data-id="35000396082">8:15</option>
<option value="8:30" data-id="35000396083">8:30</option>
<option value="8:45" data-id="35000396084">8:45</option>
<option value="9:00" data-id="35000396085">9:00</option>
<option value="9:15" data-id="35000396086">9:15</option>
<option value="9:30" data-id="35000396087">9:30</option>
<option value="9:45" data-id="35000396088">9:45</option>
<option value="10:00" data-id="35000396089">10:00</option>
<option value="10:15" data-id="35000396090">10:15</option>
<option value="10:30" data-id="35000396091">10:30</option>
<option value="10:45" data-id="35000396092">10:45</option>
<option value="11:00" data-id="35000396093">11:00</option>
<option value="11:15" data-id="35000396094">11:15</option>
<option value="11:30" data-id="35000396095">11:30</option>
<option value="11:45" data-id="35000396096">11:45</option>
<option value="12:00" data-id="35000396097">12:00</option>
<option value="12:15" data-id="35000396098">12:15</option>
<option value="12:30" data-id="35000396099">12:30</option>
<option value="12:45" data-id="35000396100">12:45</option></select>
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class=" required control-label cf_ampm_762997-label " for="helpdesk_ticket_cf_ampm_762997">AM/PM</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field dynamic_sections" id="helpdesk_ticket_custom_field_cf_ampm_762997" name="helpdesk_ticket[custom_field][cf_ampm_762997]"><option value="">...</option>
<option value="AM" data-id="35000546690">AM</option>
<option value="PM" data-id="35000546691">PM</option></select>
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class=" required control-label passenger_count_762997-label " for="helpdesk_ticket_passenger_count_762997">Total # of passengers</label>
            <div class="controls   ">
              <input class=" required number section_field span12" id="helpdesk_ticket_custom_field_passenger_count_762997" name="helpdesk_ticket[custom_field][passenger_count_762997]" size="30" type="text" />
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class=" required control-label type_of_vehicle_762997-label " for="helpdesk_ticket_type_of_vehicle_762997">Type of vehicle</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field dynamic_sections" id="helpdesk_ticket_custom_field_type_of_vehicle_762997" name="helpdesk_ticket[custom_field][type_of_vehicle_762997]"><option value="">...</option>
<option value="Sedan" data-id="35000382711">Sedan</option>
<option value="SUV" data-id="35000382712">SUV</option>
<option value="Van" data-id="35000382713">Van</option>
<option value="Sprinter Van" data-id="35000382714">Sprinter Van</option>
<option value="Limo Coach" data-id="35000382715">Limo Coach</option>
<option value="Stretch Limousine" data-id="35000382716">Stretch Limousine</option>
<option value="Mini Bus" data-id="35000382717">Mini Bus</option>
<option value="Motor Coach" data-id="35000382718">Motor Coach</option>
<option value="Trolley" data-id="35000382719">Trolley</option>
<option value="MODE Car" data-id="35000382720">MODE Car</option>
<option value="Other" data-id="35000382721">Other</option></select>
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class=" required control-label pick_up_location_762997-label " for="helpdesk_ticket_pick_up_location_762997">Pick up location</label>
            <div class="controls   ">
              <textarea class=" required paragraph section_field span12" cols="40" id="helpdesk_ticket_custom_field_pick_up_location_762997" name="helpdesk_ticket[custom_field][pick_up_location_762997]" rows="6">
</textarea>
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class="  control-label additional_stops_762997-label " for="helpdesk_ticket_additional_stops_762997">Additional stops or itinerary info</label>
            <div class="controls   ">
              <textarea class="  paragraph section_field span12" cols="40" id="helpdesk_ticket_custom_field_additional_stops_762997" name="helpdesk_ticket[custom_field][additional_stops_762997]" rows="6">
</textarea>
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class=" required control-label drop_off_location_762997-label " for="helpdesk_ticket_drop_off_location_762997">Drop off location</label>
            <div class="controls   ">
              <textarea class=" required paragraph section_field span12" cols="40" id="helpdesk_ticket_custom_field_drop_off_location_762997" name="helpdesk_ticket[custom_field][drop_off_location_762997]" rows="6">
</textarea>
            </div> 
                </div>

<div class="control-group ticket_section">
                 <label class=" required control-label cf_position_762997-label " for="helpdesk_ticket_cf_position_762997">Position of Interest</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field dynamic_sections" id="helpdesk_ticket_custom_field_cf_position_762997" name="helpdesk_ticket[custom_field][cf_position_762997]"><option value="">...</option>
<option value="Chauffeur" data-id="35000546682">Chauffeur</option>
<option value="CDL Chauffeur" data-id="35000546683">CDL Chauffeur</option>
<option value="Mechanic" data-id="35000546684">Mechanic</option>
<option value="Porter/Detailer" data-id="35000546685">Porter/Detailer</option>
<option value="Customer Service" data-id="35000546686">Customer Service</option>
<option value="Dispatcher" data-id="35000546687">Dispatcher</option>
<option value="Sales Associate" data-id="35000546688">Sales Associate</option>
<option value="Other" data-id="35000546689">Other</option></select>
            </div> 
                </div>

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