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<div class="control-group ticket_section"> <label class=" required control-label cf_ordernummer814139_1486118-label " for="helpdesk_ticket_cf_ordernummer814139_1486118">Ordernummer</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_ordernummer814139_1486118]" id="helpdesk_ticket_custom_field_cf_ordernummer814139_1486118" /> </div> </div>
<div class="control-group ticket_section"> <label class=" required control-label cf_ordernummer660720_1486118-label " for="helpdesk_ticket_cf_ordernummer660720_1486118">Ordernummer</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_ordernummer660720_1486118]" id="helpdesk_ticket_custom_field_cf_ordernummer660720_1486118" /> </div> </div>
<div class="control-group ticket_section"> <label class=" required control-label cf_ordernummer_1486118-label " for="helpdesk_ticket_cf_ordernummer_1486118">Ordernummer</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_ordernummer_1486118]" id="helpdesk_ticket_custom_field_cf_ordernummer_1486118" /> </div> </div>
<div class="control-group ticket_section"> <label class=" required control-label cf_winkel_1486118-label " for="helpdesk_ticket_cf_winkel_1486118">Winkel</label> <div class="controls "> <select class=" required dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_winkel_1486118]" id="helpdesk_ticket_custom_field_cf_winkel_1486118"><option value="">...</option> <option data-id="77000280235" value="Amersfoort">Amersfoort</option> <option data-id="77000280236" value="Duiven">Duiven</option> <option data-id="77000280237" value="Garage">Garage</option> <option data-id="77000280238" value="Maastricht">Maastricht</option> <option data-id="77000280239" value="Sliedrecht">Sliedrecht</option> <option data-id="77000280240" value="Zaandam">Zaandam</option></select> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_artikelnummer_of_omschrijving_1486118-label " for="helpdesk_ticket_cf_artikelnummer_of_omschrijving_1486118">Artikelnummer of Omschrijving</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_artikelnummer_of_omschrijving_1486118]" id="helpdesk_ticket_custom_field_cf_artikelnummer_of_omschrijving_1486118" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_telefoonnummer274951_1486118-label " for="helpdesk_ticket_cf_telefoonnummer274951_1486118">Telefoonnummer</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_telefoonnummer274951_1486118]" id="helpdesk_ticket_custom_field_cf_telefoonnummer274951_1486118" /> </div> </div>
<div class="control-group ticket_section"> <label class=" required control-label cf_winkel_1486118-label " for="helpdesk_ticket_cf_winkel_1486118">Winkel</label> <div class="controls "> <select class=" required dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_winkel_1486118]" id="helpdesk_ticket_custom_field_cf_winkel_1486118"><option value="">...</option> <option data-id="77000280235" value="Amersfoort">Amersfoort</option> <option data-id="77000280236" value="Duiven">Duiven</option> <option data-id="77000280237" value="Garage">Garage</option> <option data-id="77000280238" value="Maastricht">Maastricht</option> <option data-id="77000280239" value="Sliedrecht">Sliedrecht</option> <option data-id="77000280240" value="Zaandam">Zaandam</option></select> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_artikelnummer_of_omschrijving721182_1486118-label " for="helpdesk_ticket_cf_artikelnummer_of_omschrijving721182_1486118">Artikelnummer of Omschrijving</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_artikelnummer_of_omschrijving721182_1486118]" id="helpdesk_ticket_custom_field_cf_artikelnummer_of_omschrijving721182_1486118" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_telefoonnummer287228_1486118-label " for="helpdesk_ticket_cf_telefoonnummer287228_1486118">Telefoonnummer</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_telefoonnummer287228_1486118]" id="helpdesk_ticket_custom_field_cf_telefoonnummer287228_1486118" /> </div> </div>
<div class="control-group ticket_section"> <label class=" required control-label cf_naam_1486118-label " for="helpdesk_ticket_cf_naam_1486118">Naam</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_naam_1486118]" id="helpdesk_ticket_custom_field_cf_naam_1486118" /> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_adres_1486118-label " for="helpdesk_ticket_cf_adres_1486118">Adres</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_adres_1486118]" id="helpdesk_ticket_custom_field_cf_adres_1486118" /> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_postcode_1486118-label " for="helpdesk_ticket_cf_postcode_1486118">Postcode</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_postcode_1486118]" id="helpdesk_ticket_custom_field_cf_postcode_1486118" /> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_plaats_1486118-label " for="helpdesk_ticket_cf_plaats_1486118">Plaats</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_plaats_1486118]" id="helpdesk_ticket_custom_field_cf_plaats_1486118" /> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_telefoonnummer_1486118-label " for="helpdesk_ticket_cf_telefoonnummer_1486118">Telefoonnummer</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_telefoonnummer_1486118]" id="helpdesk_ticket_custom_field_cf_telefoonnummer_1486118" /> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_winkel_1486118-label " for="helpdesk_ticket_cf_winkel_1486118">Winkel</label> <div class="controls "> <select class=" required dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_winkel_1486118]" id="helpdesk_ticket_custom_field_cf_winkel_1486118"><option value="">...</option> <option data-id="77000280235" value="Amersfoort">Amersfoort</option> <option data-id="77000280236" value="Duiven">Duiven</option> <option data-id="77000280237" value="Garage">Garage</option> <option data-id="77000280238" value="Maastricht">Maastricht</option> <option data-id="77000280239" value="Sliedrecht">Sliedrecht</option> <option data-id="77000280240" value="Zaandam">Zaandam</option></select> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_winkel650930_1486118-label " for="helpdesk_ticket_cf_winkel650930_1486118">Levering</label> <div class="controls "> <select class=" required dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_winkel650930_1486118]" id="helpdesk_ticket_custom_field_cf_winkel650930_1486118"><option value="">...</option> <option data-id="77000280260" value="Levering aan huis">Levering aan huis</option> <option data-id="77000280261" value="Afhalen bij Loods 5 in Amersfoort">Afhalen bij Loods 5 in Amersfoort</option> <option data-id="77000280262" value="Afhalen bij Loods 5 in Duiven">Afhalen bij Loods 5 in Duiven</option> <option data-id="77000280263" value="Afhalen bij Loods 5 in Maastricht">Afhalen bij Loods 5 in Maastricht</option> <option data-id="77000280264" value="Afhalen bij Loods 5 in Sliedrecht">Afhalen bij Loods 5 in Sliedrecht</option> <option data-id="77000280265" value="Afhalen bij Loods 5 in Zaandam">Afhalen bij Loods 5 in Zaandam</option></select> </div> </div>
<div class="control-group ticket_section"> <label class=" required control-label cf_ordernummer729620_1486118-label " for="helpdesk_ticket_cf_ordernummer729620_1486118">Ordernummer</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_ordernummer729620_1486118]" id="helpdesk_ticket_custom_field_cf_ordernummer729620_1486118" /> </div> </div> <div class="control-group ticket_section"> <div class="controls"> <label class="checkbox required"> <input type="checkbox" name="helpdesk_ticket[custom_field][cf_ik_heb_een_bijlage_toegevoegd_1486118]" id="helpdesk_ticket_custom_field_cf_ik_heb_een_bijlage_toegevoegd_1486118_77000280226" value="1" class=" required checkbox section_field" /> Ik heb een bijlage toegevoegd </label> </div> </div>
<div class="control-group ticket_section"> <label class=" required control-label cf_telefoonnummer864142_1486118-label " for="helpdesk_ticket_cf_telefoonnummer864142_1486118">Telefoonnummer</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_telefoonnummer864142_1486118]" id="helpdesk_ticket_custom_field_cf_telefoonnummer864142_1486118" /> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_winkel_1486118-label " for="helpdesk_ticket_cf_winkel_1486118">Winkel</label> <div class="controls "> <select class=" required dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_winkel_1486118]" id="helpdesk_ticket_custom_field_cf_winkel_1486118"><option value="">...</option> <option data-id="77000280235" value="Amersfoort">Amersfoort</option> <option data-id="77000280236" value="Duiven">Duiven</option> <option data-id="77000280237" value="Garage">Garage</option> <option data-id="77000280238" value="Maastricht">Maastricht</option> <option data-id="77000280239" value="Sliedrecht">Sliedrecht</option> <option data-id="77000280240" value="Zaandam">Zaandam</option></select> </div> </div>
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