<h3><?=Dict::_('TTLSUPPORT')?></h3>
<form name="crm-feedback" class="form-horisontal" style="display: block;" autocomplete="off" method="post">
<div class="row">
	<div class="col-lg-8 col-md-8 col-sm-12">
		<?include_once(ROOT . '/functions/crm-feedback.php');?>
		<div class="panel panel-default">
			<div class="panel-body">
				<div class="form-group">
					<div class="input-group">
						<span class="input-group-addon" title="<?=Dict::_('TXTSUBJECT')?>"><i class="fa fa-fw fa-question-circle" aria-hidden="true"></i></span>
						<select id="inputSubject" class="form-control" name="inputSubject" required>
							<option><?=Dict::_('TXTSUBJECT00')?></option>
							<option><?=Dict::_('TXTSUBJECT01')?></option>
							<option><?=Dict::_('TXTSUBJECT02')?></option>
							<option><?=Dict::_('TXTSUBJECT03')?></option>
							<option><?=Dict::_('TXTSUBJECT04')?></option>
							<option><?=Dict::_('TXTSUBJECT05')?></option>
							<option><?=Dict::_('TXTSUBJECT0X')?></option>
						</select>
					</div>
					<input id="inputName" class="hide" name="inputName" value="<? echo $nCRMusername ?>" type="text" required>
					<input id="inputSN" class="hide" name="inputSN" type="text" value="<? echo $nCRMsn ?>" required>
					<input id="inputEmail" class="hide" name="inputEmail" type="email" value="<? echo $nCRMuseremail ?>" required>
				</div>
				<div class="form-group" style="margin-bottom: 0px;">
					<textarea id="inputMessage" class="form-control" name="inputMessage" rows="12" placeholder="<?=Dict::_('TXTMESSAGE')?>" required></textarea>
				</div>
			</div>
		</div>
	</div>
	<div class="col-lg-4 col-md-4 col-sm-12">
		<div class="input-group input-group-lg" style="width:100%;margin:0px 0px 20px 0px;">
			<span class="input-group-addon"><i class="fa fa-fw fa-arrow-right" aria-hidden="true"></i></span>
			<div class="input-group-btn" style="width:100%;"><button class="btn btn-lg btn-block btn-success" type="submit" name="FeedbackSend" style="height:46px;"><?=Dict::_('TXTSENDMESS')?></button></div>
		</div>
		<div class="panel panel-default">
			<div class="panel-heading">
				<h3 class="panel-title"><i class="fa fa-fw fa-info-circle" aria-hidden="true"></i> <?=Dict::_('TXTATTENTION')?></h3>
			</div>
			<div class="panel-body">
				<?=Dict::_('TXTATTENTION3')?>
				<? if($nCRMsn != '') { ?>
				<hr style="margin:20px 0px 15px 0px;" />
				<div class="row">
					<div class="col-lg-12 centered">
						Техподдержка до: <?php echo $nCRMdate; ?>
						<?php if ($nCRMdateTo > $nCRMdateFrom) {echo ' (<span class="clr_low" title="'.Dict::_('DAYSLEFT').'">+' . $nCRMdateFrom->diff( $nCRMdateTo )->format( '%a' ) . ')</span>';}?>
					</div>
				</div>
				<? } ?>
			</div>
		</div>
	</div>
</div>
</form>