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HTML
<STYLE TYPE='text/css'>
#loading{
display:none;
vertical-align:relativebaseline;
position:relativefixed;
left:0;
top:1700;
width:100%;
height:100%;
z-index:1000;}
#loadingcontent{
position:inheritfixed;
left:35%20%;
top:45%35%;
width:50%;
height:50%;}
#loadingspinner{
vertical-align:inheritbaseline;
width: 40%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: 14px12px;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<link idrel="loadingstylesheet">
<div idtype="loadingcontent">
<img id="loadingspinner" src="text/css" href="http://wwwaui-cdn.teamleadatlassian.rucom/download/attachments/25591816/loader.gif?api=v2" alt="Loading"/>aui-adg/5.4.3/css/aui.css"> <br/> <div id="loading">
<div id="loadingcontent">
<span id='loadingspinner' class='aui-icon aui-icon-wait'>Loading...</span>
</div>
</div>

<div id='feedback-main-div' style='font-size: 14px12px; 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='httpshttp://jiraclone-teamlead.teamlead.ru//plugins/servlet/feedback/create'>
<input type='hidden' name='form-index' id='form-index' value='118'/>
<div><select id='feedback-priority' class='select' name='feedback-priority'>
<option value='' selected >Priority</option>
<option value='1'>Блокирующий</option>
<option value='2'>Критический</option>
<option value='3'/>
 
<div>
<input type='hidden>Важный</option>
<option value='4'>Желательный</option>
<option value='5'>Незначительный</option>
</select>
</div>
<br> <div><input type='text' class='text long-field' id='feedback-summary' name='feedback-summary' class='feedback-summary' placeholder='Тема обращенияSummary' value='Запрос на хостинг'/>
<></div>

<br>
 <div style='display:none;'>
<input><input type='text' class='text long-field' id='feedback-language' name='feedback-language' class='feedback-language' placeholder='Выберите язык (en/ru)' value='ru'/>
</div>

<div>
<select class="select"></div>
<div><TEXTAREA id='feedback-body' class='textarea long-field' name='feedback-body' ROWS='5' placeholder='You can specify the details ...'></TEXTAREA></div>
<br> <fieldset class='group'>
<legend><span>Продукт</span></legend>
<div class='checkbox'>
<input type='checkbox' value='11484' name='customfield_13241' id='customfield_13241-1' nameclass='checkbox'>
<label for='customfield_13241-1'>
<option value='11484' selected>JIRA</option>
<option value='11485'>Confluence</option>
<option value='11489'>Bamboo</option>
<option value='11491'>Bitbucket</option>
</select>
</div>
 
<div>
https://<input class="text" type='text' id='customfield_12740' pattern="^[A-Za-z0-9\-_]*$" name='customfield_12740' placeholder='Придумайте веб-адрес инсталляции' size='38' />.teamlead.ru (после пробного периода можно будет использовать ваш домен)
<p>При вводе допускаются только строчные символы на латинице и цифры.
</div>

<br>
<div>
<TEXTAREA class="textarea long-field" id='feedback-body' required name='feedback-body' ROWS='5' placeholder='Тут можно указать подробности...'></TEXTAREA>
</div>
<br>
<div>
<input class="text" type='text>JIRA</label>
</div>
<div class='checkbox'>
<input type='checkbox' value='11485' name='customfield_13241' id='customfield_13241-2' class='checkbox'>
<label for='customfield_13241-2'>Confluence</label>
</div>
<div class='checkbox'>
<input type='checkbox' value='15480' name='customfield_13241' id='customfield_13241-3' class='checkbox'>
<label for='customfield_13241-3'>Service Desk</label>
</div>
<div class='checkbox'>
<input type='checkbox' value='11492' name='customfield_13241' id='customfield_13241-4' class='checkbox'>
<label for='customfield_13241-4'>Agile</label>
</div>
<div class='checkbox'>
<input type='checkbox' value='11486' name='customfield_13241' id='customfield_13241-5' class='checkbox'>
<label for='customfield_13241-5'>Crowd</label>
</div>
<div class='checkbox'>
<input type='checkbox' value='11487' name='customfield_13241' id='customfield_13241-6' class='checkbox'>
<label for='customfield_13241-6'>FishEye</label>
</div>
<div class='checkbox'>
<input type='checkbox' value='11488' name='customfield_13241' id='customfield_13241-7' class='checkbox'>
<label for='customfield_13241-7'>Crucible</label>
</div>
<div class='checkbox'>
<input type='checkbox' value='11489' name='customfield_13241' id='customfield_13241-8' class='checkbox'>
<label for='customfield_13241-8'>Bamboo</label>
</div>
<div class='checkbox'>
<input type='checkbox' value='11490' name='customfield_13241' id='customfield_13241-9' class='checkbox'>
<label for='customfield_13241-9'>Clover</label>
</div>
<div class='checkbox'>
<input type='checkbox' value='11493' name='customfield_13241' id='customfield_13241-10' class='checkbox'>
<label for='customfield_13241-10'>Team Calendars</label>
</div>
<div class='checkbox'>
<input type='checkbox' value='11494' name='customfield_13241' id='customfield_13241-11' class='checkbox'>
<label for='customfield_13241-11'>SharePoint Connector</label>
</div>
<div class='checkbox'>
<input type='checkbox' value='11491' name='customfield_13241' id='customfield_13241-12' class='checkbox'>
<label for='customfield_13241-12'>Bitbucket</label>
</div>
<div class='checkbox'>
<input type='checkbox' value='11987' name='customfield_13241' id='customfield_13241-13' class='checkbox'>
<label for='customfield_13241-13'>Capture</label>
</div>
<div class='checkbox'>
<input type='checkbox' value='11497' name='customfield_13241' id='customfield_13241-14' class='checkbox'>
<label for='customfield_13241-14'>OnDemand</label>
</div>
<div class='checkbox'>
<input type='checkbox' value='12081' name='customfield_13241' id='customfield_13241-15' class='checkbox'>
<label for='customfield_13241-15'>Stash</label>
</div>
<div class='checkbox'>
<input type='checkbox' value='12082' name='customfield_13241' id='customfield_13241-16' class='checkbox'>
<label for='customfield_13241-16'>HipChat</label>
</div>
</fieldset>
<div><select class='select' id='customfield_20741' name='customfield_20741'>
<option value='' >Версия</option>
<option value='27116'>jira</option>
<option value='27117'>conf</option>
</select>
<select id='customfield_20741_1' name='customfield_20741_1'>
</select>
<script type='text/javascript'>
jQuery(window).load(function()
{
jQuery('#customfield_20741').change(function()
{
var val = jQuery('#customfield_20741 option:selected').val();
jQuery('#customfield_20741_1').empty();
if (val == '27116')
{
jQuery('#customfield_20741_1').append('<option value="27118">5.6.6</option>');
jQuery('#customfield_20741_1').append('<option value="27119">6.5.5</option>');
}
else if (val == '27117')
{
}
});
});
</script>
</div>
<input type='text' class='text long-field' id='feedback-email' required name='feedback-email' placeholder='Ваш eE-mail' size='38' value=''/>
</div>
 
<div><br> <div align="right"> 
<input classtype="aui-'button' class='aui-button-primary" type='button' value=' ХочуAsk хостинг! ' onclick='addFeedback()'/>
</div>
</form>
</div>

<iframeform></div>
<div id='feedback-back' class='aui' style='display: none'><input type='button' class='aui-button' onclick='jQuery('#feedback-main-div').show();jQuery('#feedback-response').hide();jQuery('#feedback-back').hide();' value='Back'/></div><iframe id='feedback-response' name='feedback-response' frameborder='no' style='display: none' width='600500' height='250'>
</iframe>
 
<div id='feedback-new-issue-div'>
</div>
 
<script ></iframe><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 message = '';
   var summary = jQuery('#feedback-summary').val();
   var email = jQuery('#feedback-email').val();
var address = jQuery("#customfield_12740").val();
 if if (summary == '' || email == '')
   {
    var message = '';
    if (summary == '')
    {
     message = message + '<div><h3><font color="red">Введите тему обращения</font></h3></<div>Enter the summary</div>';
    }
    if (email == '')
    {
     message = message + '<div><h3><font color="red">Введите E-mail для ответа</font></h3><<div>Enter E-mail</div>';
    }
	if (address.trim() == '') 
	{ 
	message = message + '<div><h3><font color="red">Введите адрес вашей инсталляции</font></h3></div>';
	}
    jQuery("'#feedback-error"').html(message);
    return false;
}
var webdomainPatter = /^[a-z0-9]*$/;
if ( !webdomainPatter.test(address ) )
{
        jQuery("'#feedback-error"').html('<div><h3><font color="red">При вводе допускаются только строчные символы на латинице и цифры</font></h3></div>');
 return false;
}

   jQuery('#feedback-errormain-div').htmlhide('');
   jQuery('#feedback-main-div#loading').hidefadeIn();
   jQuery('#loading#feedback-response').fadeInshow();
   jQuery('#feedback-responseback').show();
   jQuery('#feedback-form').submit();
   jQuery('#feedback-response').on("load", function() {
   jQuery('#feedback-new-issue-div').show();
   jQuery('#loading').fadeOut();
}); 
   return false;
}
</script>

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