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HTML
<STYLE TYPE='text/css'>
#loading{
display:none;
vertical-align:baseline;
position:fixed;
left:0;
top:0;
width:100%;
height:100%;
z-index:1000;}
#loadingcontent{
position:fixed;
left:20%;
top:35%;
width:50%;
height:50%;}
#loadingspinner{
vertical-align:baseline;
width: 10%;
text-align: center;
font-size:larger;} 
textarea { width: 100%; margin: 0; padding: 0; border-width: 1; }
.feedback-summary { width: 100%; margin: 0; padding: 0; border-width: 1; }
BODY, input, select, table {
font-size: 16px20px;font-family: Arial,Helvetica,FreeSans,'sans - serif';}
</STYLE>
<script src='http://ajax.googleapis.com/ajax/libs/jquery/1.7.1/jquery.min.js'></script> 

<div id="loading">
<div id="loadingcontent">
<img id="loadingspinner" src="http://www.teamlead.ru/download/attachments/25591816/loader.gif?api=v2" alt="Loading"/>
</div>
</div>
<div id='feedback-main-div' style='font-size: 16px20px; font-family: Arial,Helvetica,FreeSans,sans-serif'>
<div id='feedback-error'></div>

<form class="aui" enctype='multipart/form-data' id='feedback-form' name='feedback-form' target='feedback-response' method='post' action='http://jira.teamlead.ru/plugins/servlet/feedback/create'>

<input type='hidden' name='form-index' id='form-index' value='15'/>

<div>
<select class="select" id='feedback-issue-type' name='feedback-issue-type'>
<option value='' selected >Тип запроса</option>
<option value='10000'>IT Help</option>
<option value='10001'>Purchase</option>
<option value='10002'>Change</option>
<option value='10003'>Fault</option>
</select>
</div>
 
<div>
<select class="select" id="feedback-component" data-placeholder="Выберите продукт..." name='feedback-component'>
<option value='18261'>Intranet</option>
<option value='18260'>JIRA</option>
<option value='18262'>Public website</option>
</select>
<script>
AJS.$("#feedback-component").auiSelect2();
</script>
</div>
 
<div>
<select id="feedback-fix-version" multiple data-placeholder="Выберите продукт..." name='feedback-fix-version'>
<option value='23621'>JIRA</option>
<option value='23622'>Confluence</option>
<option value='23623'>CRM for JIRA</option>
<option value='23624'>JIRA Service Desk</option>
</select>
<script>
AJS.$("#feedback-fix-version").auiSelect2();
</script>
</div>
 
<div>
<input class="text long-field" type='text' id='feedback-summary' name='feedback-summary' class='feedback-summary' placeholder='Тема обращения' value=''/>
</div>

 
<div>
<TEXTAREA class="textarea long-field" id='feedback-body' name='feedback-body' ROWS='5' placeholder='Тут можно указать подробности...'></TEXTAREA>
</div>
<br>

<div>
<input class="text" type='text' id='feedback-email' name='feedback-email' placeholder='E-mail для ответа' size='38' value=''/>
</div>
 
<div>
<input class="text" type='file' id='feedback-attachment' name='feedback-attachment' size='38' />
</div>
 
<div> 
<input class="aui-button aui-button-primary" type='button' value=' Отправить ' onclick='addFeedback()'/>
</div>
</form>
</div>
<iframe id='feedback-response' name='feedback-response' frameborder='no' style='display: none' width='450' height='200'>
</iframe>
 
<div id='feedback-new-issue-div'>
<input class="aui-button aui-button-primary" type='button' id='feedback-new-issue-button' value='Создать еще запрос'>
</div>
 
<script type='text/javascript'>
jQuery(window).load(function()
{
   jQuery('#feedback-main-div').show();
   jQuery('#feedback-new-issue-div').hide();
   jQuery('#feedback-response').hide();
   jQuery('#feedback-new-issue-button').click(function ()
   {
    jQuery('#feedback-form')[0].reset();
    jQuery('#feedback-main-div').show();
    jQuery('#feedback-new-issue-div').hide();
    jQuery('#feedback-response').hide();
   });
});

function addFeedback() {
   var summary = jQuery('#feedback-summary').val();
   var email = jQuery('#feedback-email').val();
   if (summary == '' || email == '')
   {
    var message = '';
    if (summary == '')
    {
     message = message + '<div>Введите тему обращения</div>';
    }
    if (email == '')
    {
     message = message + '<div>Введите E-mail для ответа</div>';
    }
    jQuery('#feedback-error').html(message);
    return false;
}
   jQuery('#feedback-error').html('');
   jQuery('#feedback-main-div').hide();
   jQuery('#loading').fadeIn();
   jQuery('#feedback-response').show();
   jQuery('#feedback-form').submit();
   jQuery('#feedback-response').on("load", function() {
   jQuery('#feedback-new-issue-div').show();
   jQuery('#loading').fadeOut();
}); 
   return false;
}
</script>