Playbrush Widget

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<div class="control-group ticket_section">
                 <label class=" required control-label cf_product_413554-label " for="helpdesk_ticket_cf_product_413554">Which Subscription do you want to cancel?</label>
            <div class="controls nested_field  ">
              <select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_product_413554_17000545426" name="helpdesk_ticket[custom_field][cf_product_413554]"><option value="">...</option>
<option value="Smart Sonic / GUM Playbrush (Sonic Toothbrush for Kids))">Smart Sonic / GUM Playbrush (Sonic Toothbrush for Kids))</option>
<option value="Smart One X / GUM Smart One (Sonic toothbrush for Adults)">Smart One X / GUM Smart One (Sonic toothbrush for Adults)</option>
<option value="Playbrush Smart ( for manuel toothbrushes)">Playbrush Smart ( for manuel toothbrushes)</option></select><div class="level_2"><label class="required">Do you still use your Playbrush?</label><select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_use_playbrush_413554_17000545426" name="helpdesk_ticket[custom_field][cf_use_playbrush_413554]"><option value="">...</option>
</select></div><div class="level_3"><label class="required">Reason for cancelling</label><select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_cancellation_reason_1_413554_17000545426" name="helpdesk_ticket[custom_field][cf_cancellation_reason_1_413554]"><option value="">...</option>
</select></div><script>
//<![CDATA[
jQuery('#helpdesk_ticket_custom_field_cf_product_413554_17000545426').nested_select_tag({"data_tree":[["Smart Sonic / GUM Playbrush (Sonic Toothbrush for Kids))","Smart Sonic / GUM Playbrush (Sonic Toothbrush for Kids))",[["I don't use the brush any more, because...","I don't use the brush any more, because...",[["A1) the brush is defect","A1) the brush is defect"],["A2) the app doesn´t work","A2) the app doesn´t work"],["A3a) my child is too young","A3a) my child is too young"],["A3b) my child is too old","A3b) my child is too old"],["A4a) the vibration was too strong","A4a) the vibration was too strong"],["A4a) the vibration was too weak","A4a) the vibration was too weak"],["A5a) the Bristles were too big","A5a) the Bristles were too big"],["A5a) the Bristles were too soft","A5a) the Bristles were too soft"]]],["I use the brush, but","I use the brush, but",[["B1) the app no longer","B1) the app no longer"],["B2) the subscription is too expensive","B2) the subscription is too expensive"]]]]],["Smart One X / GUM Smart One (Sonic toothbrush for Adults)","Smart One X / GUM Smart One (Sonic toothbrush for Adults)",[["I don't use the brush any more, because...","I don't use the brush any more, because...",[["A1) the brush is defect","A1) the brush is defect"],["A2) the app doesn´t work","A2) the app doesn´t work"],["A4a) the vibration was too strong","A4a) the vibration was too strong"],["A4b) the vibration was too weak","A4b) the vibration was too weak"],["A5a) the Bristles were too big","A5a) the Bristles were too big"],["A5b) Bristles are too soft","A5b) Bristles are too soft"]]],["I use the brush, but","I use the brush, but",[["B1) the app no longer","B1) the app no longer"],["B2) the subscription is too expensive","B2) the subscription is too expensive"]]]]],["Playbrush Smart ( for manuel toothbrushes)","Playbrush Smart ( for manuel toothbrushes)",[["We don´t use our subscription, because...","We don´t use our subscription, because...",[["A1) the brush is defect","A1) the brush is defect"],["A2) the app doesn´t work","A2) the app doesn´t work"],["A3a) my child is too young","A3a) my child is too young"],["A3b) my child is too old","A3b) my child is too old"],["B2) the sub is too expensive","B2) the sub is too expensive"],["E) We want change to a electrical brush","E) We want change to a electrical brush"]]]]]],"initValues":null,"disable_children":false,"include_blank":"...","selected":null,"pl_value_id":"17000545426","subcategory_id":"helpdesk_ticket_custom_field_cf_use_playbrush_413554_17000545426","item_id":"helpdesk_ticket_custom_field_cf_cancellation_reason_1_413554_17000545426"});
//]]>
</script>
            </div> 
                </div>

<div class="control-group ticket_section">
                 <label class=" required control-label cf_pb_device_413554-label " for="helpdesk_ticket_cf_pb_device_413554">Which Playbrush do you use?</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_pb_device_413554]" id="helpdesk_ticket_custom_field_cf_pb_device_413554"><option value="">...</option>
<option data-id="17000378096" value="GUM Playbrush / Smart Sonic (for kids)">GUM Playbrush / Smart Sonic (for kids)</option>
<option data-id="17000490582" value="GUM Smart One / Smart One X (for adults)">GUM Smart One / Smart One X (for adults)</option>
<option data-id="17000378095" value="Playbrush Smart (manual attachment)">Playbrush Smart (manual attachment)</option>
<option data-id="17000378097" value="Playbrush Smart One (for adults)">Playbrush Smart One (for adults)</option></select>
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class=" required control-label cf_costumer_device_413554-label " for="helpdesk_ticket_cf_costumer_device_413554">Which mobile device do you use?</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_costumer_device_413554]" id="helpdesk_ticket_custom_field_cf_costumer_device_413554"><option value="">...</option>
<option data-id="17000378064" value="iPhone">iPhone</option>
<option data-id="17000378065" value="Android (Samsung, Huawei, etc.)">Android (Samsung, Huawei, etc.)</option>
<option data-id="17000378066" value="Amazon Tablet">Amazon Tablet</option>
<option data-id="17000378121" value="other">other</option></select>
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class=" required control-label cf_pb_413554-label " for="helpdesk_ticket_cf_pb_413554">Which app is causing problems?</label>
            <div class="controls nested_field  ">
              <select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_pb_413554_17000545429" name="helpdesk_ticket[custom_field][cf_pb_413554]"><option value="">...</option>
<option value="GUM Playbrush App">GUM Playbrush App</option>
<option value="GUM SMART App ( for adults)">GUM SMART App ( for adults)</option></select><div class="level_2"><label class="required">Which function</label><select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_pdf_413554_17000545429" name="helpdesk_ticket[custom_field][cf_pdf_413554]"><option value="">...</option>
</select></div><div class="level_3"><label class="required">Which game</label><select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_ff_413554_17000545429" name="helpdesk_ticket[custom_field][cf_ff_413554]"><option value="">...</option>
</select></div><script>
//<![CDATA[
jQuery('#helpdesk_ticket_custom_field_cf_pb_413554_17000545429').nested_select_tag({"data_tree":[["GUM Playbrush App","GUM Playbrush App",[["tooth brushing coach","tooth brushing coach",[]],["Statistics","Statistics",[]],["In-App games","In-App games",[["Fridolin Frog","Fridolin Frog"],["penalties shoot","penalties shoot"],["Super Stars","Super Stars"],["Your Song","Your Song"],["Draw like Picasso","Draw like Picasso"],["lane change","lane change"],["3 wins","3 wins"],["Dayo Kart","Dayo Kart"]]],["Utoothia","Utoothia",[]],["Utoothia Paint","Utoothia Paint",[]],["Utoothia Magic","Utoothia Magic",[]],["Utoothia Sky","Utoothia Sky",[]],["Utoothia Dance","Utoothia Dance",[]],["Others","Others",[]]]],["GUM SMART App ( for adults)","GUM SMART App ( for adults)",[["tooth brushing coach","tooth brushing coach",[]],["Statistics","Statistics",[]],["Quiz-Game","Quiz-Game",[]]]]],"initValues":null,"disable_children":false,"include_blank":"...","selected":null,"pl_value_id":"17000545429","subcategory_id":"helpdesk_ticket_custom_field_cf_pdf_413554_17000545429","item_id":"helpdesk_ticket_custom_field_cf_ff_413554_17000545429"});
//]]>
</script>
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class=" required control-label cf_software_issue_413554-label " for="helpdesk_ticket_cf_software_issue_413554">Which problem do you have?</label>
            <div class="controls   ">
              <select class=" required dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_software_issue_413554]" id="helpdesk_ticket_custom_field_cf_software_issue_413554"><option value="">...</option>
<option data-id="17000378069" value="Connection problems">Connection problems</option>
<option data-id="17000378070" value="statistic missing">statistic missing</option>
<option data-id="17000378071" value="Login don´t work">Login don´t work</option>
<option data-id="17000378072" value="I can't get any further in the game">I can't get any further in the game</option>
<option data-id="17000378073" value="it shows me the wrong page">it shows me the wrong page</option>
<option data-id="17000378074" value="Problems with pressure sensor "You brush too hard"">Problems with pressure sensor "You brush too hard"</option></select>
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class=" required control-label cf_pb_email_413554-label " for="helpdesk_ticket_cf_pb_email_413554">Which E-Mail do you use in the app</label>
            <div class="controls   ">
              <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_pb_email_413554]" id="helpdesk_ticket_custom_field_cf_pb_email_413554" />
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class="  control-label cf_pb_profile_name_413554-label " for="helpdesk_ticket_cf_pb_profile_name_413554">Whats your profile name?</label>
            <div class="controls   ">
              <input class="  text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_pb_profile_name_413554]" id="helpdesk_ticket_custom_field_cf_pb_profile_name_413554" />
            </div> 
                </div>

<div class="control-group ticket_section">
                 <label class=" required control-label cf_order_number632619_413554-label " for="helpdesk_ticket_cf_order_number632619_413554">Order number</label>
            <div class="controls   ">
              <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_order_number632619_413554]" id="helpdesk_ticket_custom_field_cf_order_number632619_413554" />
            </div> 
                </div>
      <div class="control-group ticket_section">
                 <label class="  control-label cf_delivery_issue_413554-label " for="helpdesk_ticket_cf_delivery_issue_413554">What topic do you have questions about?</label>
            <div class="controls   ">
              <select class="  dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_delivery_issue_413554]" id="helpdesk_ticket_custom_field_cf_delivery_issue_413554"><option value="">...</option>
<option data-id="17000377794" value="Where is my Playbrush?">Where is my Playbrush?</option>
<option data-id="17000377795" value="Wrong delivery received">Wrong delivery received</option>
<option data-id="17000377796" value="Replacement Brushheads / Brushes">Replacement Brushheads / Brushes</option>
<option data-id="17000378088" value="Return">Return</option>
<option data-id="17000378089" value="Others">Others</option></select>
            </div> 
                </div>

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