METRO Cash&Carry France Widget

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Sujet

<div class="control-group ticket_section">
                 <label class=" required control-label cf_numro_de_carte_metro_839887-label " for="helpdesk_ticket_cf_numro_de_carte_metro_839887">Numéro de carte METRO</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_numro_de_carte_metro_839887" name="helpdesk_ticket[custom_field][cf_numro_de_carte_metro_839887]" size="30" type="text" />
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class="  control-label cf_tlphone_839887-label " for="helpdesk_ticket_cf_tlphone_839887">Téléphone</label>
            <div class="controls   ">
              <input class="  text section_field span12" id="helpdesk_ticket_custom_field_cf_tlphone_839887" name="helpdesk_ticket[custom_field][cf_tlphone_839887]" size="30" type="text" />
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class=" required control-label cf_entrept_de_contact_839887-label " for="helpdesk_ticket_cf_entrept_de_contact_839887">Entrepôt de contact</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field dynamic_sections" id="helpdesk_ticket_custom_field_cf_entrept_de_contact_839887" name="helpdesk_ticket[custom_field][cf_entrept_de_contact_839887]"><option value="">...</option>
<option value="Agen" data-id="15000030842">Agen</option>
<option value="Aix en Provence" data-id="15000030843">Aix en Provence</option>
<option value="Albertville" data-id="15000030844">Albertville</option>
<option value="Alès" data-id="15000030845">Alès</option>
<option value="Amiens" data-id="15000030846">Amiens</option>
<option value="Angers" data-id="15000030847">Angers</option>
<option value="Anglet" data-id="15000030848">Anglet</option>
<option value="Angoulême" data-id="15000030849">Angoulême</option>
<option value="Annecy" data-id="15000030850">Annecy</option>
<option value="Annemasse" data-id="15000030851">Annemasse</option>
<option value="Auxerre" data-id="15000030852">Auxerre</option>
<option value="Avignon" data-id="15000030853">Avignon</option>
<option value="Belfort" data-id="15000030854">Belfort</option>
<option value="Besançon" data-id="15000030855">Besançon</option>
<option value="Béziers" data-id="15000030856">Béziers</option>
<option value="Bobigny" data-id="15000030857">Bobigny</option>
<option value="Bordeaux Lac" data-id="15000030858">Bordeaux Lac</option>
<option value="Boulogne-sur-Mer" data-id="15000030859">Boulogne-sur-Mer</option>
<option value="Bourg-en-Bresse" data-id="15000030860">Bourg-en-Bresse</option>
<option value="Bourges" data-id="15000030861">Bourges</option>
<option value="Brest" data-id="15000030862">Brest</option>
<option value="Brive-la-Gaillarde" data-id="15000030863">Brive-la-Gaillarde</option>
<option value="Buchelay" data-id="15000030864">Buchelay</option>
<option value="Caen" data-id="15000030865">Caen</option>
<option value="Calais" data-id="15000030866">Calais</option>
<option value="Cannes-la-Bocca " data-id="15000030867">Cannes-la-Bocca </option>
<option value="Carcassonne" data-id="15000030868">Carcassonne</option>
<option value="Cergy" data-id="15000030869">Cergy</option>
<option value="Chalon-sur-Saône" data-id="15000030870">Chalon-sur-Saône</option>
<option value="Chambéry" data-id="15000030871">Chambéry</option>
<option value="Chamonix" data-id="15000030872">Chamonix</option>
<option value="Charleville-Mézières" data-id="15000030873">Charleville-Mézières</option>
<option value="Chartres" data-id="15000030874">Chartres</option>
<option value="Chennevières-sur-Marne" data-id="15000030875">Chennevières-sur-Marne</option>
<option value="Cherbourg" data-id="15000030876">Cherbourg</option>
<option value="Clermont-Ferrand" data-id="15000030877">Clermont-Ferrand</option>
<option value="Colmar" data-id="15000030878">Colmar</option>
<option value="Creil" data-id="15000030879">Creil</option>
<option value="Epinal" data-id="15000030880">Epinal</option>
<option value="Evry" data-id="15000030881">Evry</option>
<option value="Fréjus" data-id="15000030882">Fréjus</option>
<option value="Gauchy" data-id="15000030883">Gauchy</option>
<option value="Gradignan/Bordeaux" data-id="15000030884">Gradignan/Bordeaux</option>
<option value="Grenoble" data-id="15000030885">Grenoble</option>
<option value="Hénin-Beaumont" data-id="15000030886">Hénin-Beaumont</option>
<option value="La Roche-sur-Yon" data-id="15000030887">La Roche-sur-Yon</option>
<option value="La Rochelle" data-id="15000030888">La Rochelle</option>
<option value="Le Havre" data-id="15000030889">Le Havre</option>
<option value="Le Mans" data-id="15000030890">Le Mans</option>
<option value="Limoges" data-id="15000030891">Limoges</option>
<option value="Lomme" data-id="15000030892">Lomme</option>
<option value="Lorient" data-id="15000030893">Lorient</option>
<option value="Lyon (Limonest)" data-id="15000030894">Lyon (Limonest)</option>
<option value="Lyon (Vaulx-en-Velin)" data-id="15000030895">Lyon (Vaulx-en-Velin)</option>
<option value="Marseille (La Valentine)" data-id="15000030896">Marseille (La Valentine)</option>
<option value="Marseille (les Pennes)" data-id="15000030897">Marseille (les Pennes)</option>
<option value="Meaux" data-id="15000030898">Meaux</option>
<option value="Melun (Vaux Le Pénil)" data-id="15000030899">Melun (Vaux Le Pénil)</option>
<option value="Metz" data-id="15000030900">Metz</option>
<option value="Monaco" data-id="15000030901">Monaco</option>
<option value="Montélimar" data-id="15000030902">Montélimar</option>
<option value="Montpellier" data-id="15000030903">Montpellier</option>
<option value="Mulhouse" data-id="15000030904">Mulhouse</option>
<option value="Nancy" data-id="15000030905">Nancy</option>
<option value="Nanterre" data-id="15000030906">Nanterre</option>
<option value="Nantes" data-id="15000030907">Nantes</option>
<option value="Narbonne" data-id="15000030908">Narbonne</option>
<option value="Nice " data-id="15000030909">Nice </option>
<option value="Nîmes" data-id="15000030910">Nîmes</option>
<option value="Orléans" data-id="15000030911">Orléans</option>
<option value="Paris 12 - Bercy" data-id="15000030912">Paris 12 - Bercy</option>
<option value="Paris 18 - La chapelle" data-id="15000030913">Paris 18 - La chapelle</option>
<option value="Pau" data-id="15000030914">Pau</option>
<option value="Périgueux" data-id="15000030915">Périgueux</option>
<option value="Perpignan" data-id="15000030916">Perpignan</option>
<option value="Poitiers" data-id="15000030917">Poitiers</option>
<option value="Quimper" data-id="15000030918">Quimper</option>
<option value="Reims" data-id="15000030919">Reims</option>
<option value="Rennes" data-id="15000030920">Rennes</option>
<option value="Rouen" data-id="15000030921">Rouen</option>
<option value="Saint-Brieuc" data-id="15000030922">Saint-Brieuc</option>
<option value="Saint-Etienne" data-id="15000030923">Saint-Etienne</option>
<option value="Saint-Malo" data-id="15000030924">Saint-Malo</option>
<option value="Saint-Nazaire" data-id="15000030925">Saint-Nazaire</option>
<option value="Strasbourg" data-id="15000030926">Strasbourg</option>
<option value="Tarbes" data-id="15000030927">Tarbes</option>
<option value="Toulon" data-id="15000030928">Toulon</option>
<option value="Toulouse (Portet sur Garonne)" data-id="15000030929">Toulouse (Portet sur Garonne)</option>
<option value="Toulouse (Sesquières)" data-id="15000030930">Toulouse (Sesquières)</option>
<option value="Tours" data-id="15000030931">Tours</option>
<option value="Trappes" data-id="15000030932">Trappes</option>
<option value="Troyes" data-id="15000030933">Troyes</option>
<option value="Valence" data-id="15000030934">Valence</option>
<option value="Valenciennes" data-id="15000030935">Valenciennes</option>
<option value="Vannes" data-id="15000030936">Vannes</option>
<option value="Villeneuve-la-Garenne" data-id="15000030937">Villeneuve-la-Garenne</option>
<option value="Vitry-sur-Seine" data-id="15000030938">Vitry-sur-Seine</option>
<option value="Wattrelos" data-id="15000030939">Wattrelos</option></select>
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class=" required control-label cf_ma_demande_839887-label " for="helpdesk_ticket_cf_ma_demande_839887">Ma demande</label>
            <div class="controls   ">
              <textarea class=" required paragraph section_field span12" cols="40" id="helpdesk_ticket_custom_field_cf_ma_demande_839887" name="helpdesk_ticket[custom_field][cf_ma_demande_839887]" rows="6">
</textarea>
            </div> 
                </div>

<div class="control-group ticket_section">
                 <label class=" required control-label cf_civilit_839887-label " for="helpdesk_ticket_cf_civilit_839887">Civilité</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field dynamic_sections" id="helpdesk_ticket_custom_field_cf_civilit_839887" name="helpdesk_ticket[custom_field][cf_civilit_839887]"><option value="">...</option>
<option value="Madame" data-id="15000031273">Madame</option>
<option value="Monsieur" data-id="15000031274">Monsieur</option></select>
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class=" required control-label cf_nom_839887-label " for="helpdesk_ticket_cf_nom_839887">Nom</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_nom_839887" name="helpdesk_ticket[custom_field][cf_nom_839887]" size="30" type="text" />
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class=" required control-label cf_prnom_839887-label " for="helpdesk_ticket_cf_prnom_839887">Prénom</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_prnom_839887" name="helpdesk_ticket[custom_field][cf_prnom_839887]" size="30" type="text" />
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class="  control-label cf_activit_839887-label " for="helpdesk_ticket_cf_activit_839887">Activité</label>
            <div class="controls   ">
              <select class="  dropdown_blank section_field dynamic_sections" id="helpdesk_ticket_custom_field_cf_activit_839887" name="helpdesk_ticket[custom_field][cf_activit_839887]"><option value="">...</option>
<option value="Autre commerçant" data-id="15000030717">Autre commerçant</option>
<option value="Boulanger – Pâtissier" data-id="15000030718">Boulanger – Pâtissier</option>
<option value="Café – Bar" data-id="15000030719">Café – Bar</option>
<option value="Entreprise Prof. Libérale" data-id="15000030720">Entreprise Prof. Libérale</option>
<option value="Restauration rapide" data-id="15000030721">Restauration rapide</option>
<option value="Restauration traditionnelle" data-id="15000030722">Restauration traditionnelle</option>
<option value="Revendeur alimentaire" data-id="15000030723">Revendeur alimentaire</option>
<option value="Traiteur" data-id="15000030724">Traiteur</option></select>
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class=" required control-label cf_adresse_839887-label " for="helpdesk_ticket_cf_adresse_839887">Adresse</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_adresse_839887" name="helpdesk_ticket[custom_field][cf_adresse_839887]" size="30" type="text" />
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class=" required control-label cf_code_postal_839887-label " for="helpdesk_ticket_cf_code_postal_839887">Code postal</label>
            <div class="controls   ">
              <input class=" required number section_field span12" id="helpdesk_ticket_custom_field_cf_code_postal_839887" name="helpdesk_ticket[custom_field][cf_code_postal_839887]" size="30" type="text" />
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class=" required control-label cf_ville_839887-label " for="helpdesk_ticket_cf_ville_839887">Ville</label>
            <div class="controls   ">
              <input class=" required text section_field span12" id="helpdesk_ticket_custom_field_cf_ville_839887" name="helpdesk_ticket[custom_field][cf_ville_839887]" size="30" type="text" />
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class="  control-label cf_tlphone_839887-label " for="helpdesk_ticket_cf_tlphone_839887">Téléphone</label>
            <div class="controls   ">
              <input class="  text section_field span12" id="helpdesk_ticket_custom_field_cf_tlphone_839887" name="helpdesk_ticket[custom_field][cf_tlphone_839887]" size="30" type="text" />
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class="  control-label cf_fax_839887-label " for="helpdesk_ticket_cf_fax_839887">Fax</label>
            <div class="controls   ">
              <input class="  number section_field span12" id="helpdesk_ticket_custom_field_cf_fax_839887" name="helpdesk_ticket[custom_field][cf_fax_839887]" size="30" type="text" />
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class=" required control-label cf_ma_demande_839887-label " for="helpdesk_ticket_cf_ma_demande_839887">Ma demande</label>
            <div class="controls   ">
              <textarea class=" required paragraph section_field span12" cols="40" id="helpdesk_ticket_custom_field_cf_ma_demande_839887" name="helpdesk_ticket[custom_field][cf_ma_demande_839887]" rows="6">
</textarea>
            </div> 
                </div>

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