Customer Support
Welcome
Login
Sign up
Home
Solutions
Submit a Request
Request Type
...
BSA
Card Solutions
Cash Support
Contact Us – Customer Support
Contact the CEO
Customer Feedback_CSC
Customer Feedback
Deposit Operations
Digital Solutions
DS Risk Limit Increase
Fraud
OFAC Notification
Overdraft Support
Research Request
Submit HSA Application
Tax and Legal (Liability Support)
TM Setup
Treasury Management-TM Use Only -Forms Assistance
Treasury Pricing
Treasury Services
Zelle Support
<label class=" required control-label cf_bsa_request_type617391_870937-label " for="helpdesk_ticket_cf_bsa_request_type617391_870937">BSA Request Type</label> <div class="controls "> <select class=" required dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_bsa_request_type617391_870937]" id="helpdesk_ticket_custom_field_cf_bsa_request_type617391_870937"><option value="">...</option> <option data-id="42000295043" value="General Questions">General Questions</option> <option data-id="42000293915" value="Law Enforcement Requests">Law Enforcement Requests</option> <option data-id="42000293914" value="Notification of Activity">Notification of Activity</option> <option data-id="42000316235" value="Report Suspicious Activity">Report Suspicious Activity</option> <option data-id="42000295044" value="*Cash Transaction Log">*Cash Transaction Log</option> <option data-id="42000295047" value="*Request Verafin Access">*Request Verafin Access</option> <option data-id="42000326499" value="Digital Solutions Approval">Digital Solutions Approval</option></select> </div>
<div class="controls"> <label class="checkbox "> <input name="helpdesk_ticket[custom_field][cf_please_submit_the_appropriate_form_870937]" type="hidden" value="0" /><input class=" checkbox section_field" id="helpdesk_ticket_custom_field_cf_please_submit_the_appropriate_form_870937_42000293907" type="checkbox" value="1" name="helpdesk_ticket[custom_field][cf_please_submit_the_appropriate_form_870937]" /> (*) Please submit the appropriate form </label> </div>
<label class=" control-label cf_bsa_branch_listing_870937-label " for="helpdesk_ticket_cf_bsa_branch_listing_870937">BSA Branch Listing</label> <div class="controls "> <select class=" dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_bsa_branch_listing_870937]" id="helpdesk_ticket_custom_field_cf_bsa_branch_listing_870937"><option value="">...</option> <option data-id="42000298129" value="ALTAMONT">ALTAMONT</option> <option data-id="42000298130" value="ALTON">ALTON</option> <option data-id="42000298131" value="ARCOLA">ARCOLA</option> <option data-id="42000298132" value="BARTONVILLE">BARTONVILLE</option> <option data-id="42000347726" value="BELOIT BROAD">BELOIT BROAD</option> <option data-id="42000347727" value="BELOIT CRANSTON">BELOIT CRANSTON</option> <option data-id="42000347728" value="BELVIDERE">BELVIDERE</option> <option data-id="42000298133" value="BLOOMINGTON">BLOOMINGTON</option> <option data-id="42000298134" value="BOURBONNAIS">BOURBONNAIS</option> <option data-id="42000298135" value="C CROSSING">C CROSSING</option> <option data-id="42000298136" value="C MARKETVIEW">C MARKETVIEW</option> <option data-id="42000298137" value="C W. CHURCH">C W. CHURCH</option> <option data-id="42000298138" value="CARBONDALE MAIN">CARBONDALE MAIN</option> <option data-id="42000298139" value="CARBONDALE SCHNUCKS">CARBONDALE SCHNUCKS</option> <option data-id="42000298140" value="CARMI">CARMI</option> <option data-id="42000298141" value="CARMI DRIVES">CARMI DRIVES</option> <option data-id="42000298142" value="CARTERVILLE">CARTERVILLE</option> <option data-id="42000298143" value="CHAMPAIGN CHURCH (DOWNTOWN)">CHAMPAIGN CHURCH (DOWNTOWN)</option> <option data-id="42000298144" value="CHAMPAIGN CROSSING">CHAMPAIGN CROSSING</option> <option data-id="42000298145" value="CHAMPAIGN MARKETVIEW">CHAMPAIGN MARKETVIEW</option> <option data-id="42000298146" value="CHARLESTON 6TH ST">CHARLESTON 6TH ST</option> <option data-id="42000298147" value="CHARLESTON LINCOLN">CHARLESTON LINCOLN</option> <option data-id="42000298148" value="CLAYTON">CLAYTON</option> <option data-id="42000298149" value="COLUMBIA MO -5TH">COLUMBIA MO -5TH</option> <option data-id="42000298150" value="COLUMBIA MO -FORUM">COLUMBIA MO -FORUM</option> <option data-id="42000298151" value="COLUMBIA MO- MTG CTR">COLUMBIA MO- MTG CTR</option> <option data-id="42000325995" value="CREVE COEUR MO">CREVE COEUR MO</option> <option data-id="42000298152" value="DE SOTO">DE SOTO</option> <option data-id="42000298153" value="DECATUR AIRPORT (RT 36)">DECATUR AIRPORT (RT 36)</option> <option data-id="42000298154" value="DECATUR ELDORADO">DECATUR ELDORADO</option> <option data-id="42000298155" value="DECATUR FORSYTH">DECATUR FORSYTH</option> <option data-id="42000298156" value="DECATUR MAIN (S WATER ST)">DECATUR MAIN (S WATER ST)</option> <option data-id="42000298157" value="DECATUR NORTH MAIN">DECATUR NORTH MAIN</option> <option data-id="42000298158" value="DECATUR PERSHING">DECATUR PERSHING</option> <option data-id="42000298159" value="DECATUR S FRANKLIN (S SHORES)">DECATUR S FRANKLIN (S SHORES)</option> <option data-id="42000298160" value="EDWARDSVILLE 157">EDWARDSVILLE 157</option> <option data-id="42000298161" value="EDWARDSVILLE GOSHEN">EDWARDSVILLE GOSHEN</option> <option data-id="42000298162" value="EDWARDSVILLE ST. LOUIS ST.">EDWARDSVILLE ST. LOUIS ST.</option> <option data-id="42000298163" value="EFFINGHAM">EFFINGHAM</option> <option data-id="42000298164" value="ELSBERRY MO">ELSBERRY MO</option> <option data-id="42000325996" value="EUREKA MO">EUREKA MO</option> <option data-id="42000298165" value="FAIRVIEW HEIGHTS">FAIRVIEW HEIGHTS</option> <option data-id="42000298166" value="FORSYTH">FORSYTH</option> <option data-id="42000298167" value="GALESBURG HENDERSON">GALESBURG HENDERSON</option> <option data-id="42000298168" value="GALESBURG MAIN">GALESBURG MAIN</option> <option data-id="42000298169" value="GRAPEVINE TX- MTG CTR">GRAPEVINE TX- MTG CTR</option> <option data-id="42000298170" value="GRAPEVINE TX-PREMIER">GRAPEVINE TX-PREMIER</option> <option data-id="42000298171" value="HARRISBURG MAIN (E LOCUST)">HARRISBURG MAIN (E LOCUST)</option> <option data-id="42000298172" value="HARRISBURG SOUTH (ROLLIE MOORE)">HARRISBURG SOUTH (ROLLIE MOORE)</option> <option data-id="42000298173" value="HIGHLAND BROADWAY">HIGHLAND BROADWAY</option> <option data-id="42000298174" value="HIGHLAND MAIN (ST RT 143)">HIGHLAND MAIN (ST RT 143)</option> <option data-id="42000298175" value="INDIANAPOLIS IN">INDIANAPOLIS IN</option> <option data-id="42000347729" value="JANESVILLE WI">JANESVILLE WI</option> <option data-id="42000298176" value="JEFFERSON MO- MISSOURI">JEFFERSON MO- MISSOURI</option> <option data-id="42000298177" value="JEFFERSON MO-ELLIS">JEFFERSON MO-ELLIS</option> <option data-id="42000298178" value="JEFFERSON MO-STADIUM">JEFFERSON MO-STADIUM</option> <option data-id="42000298179" value="KNOXVILLE">KNOXVILLE</option> <option data-id="42000298180" value="LAKE ST LOUIS MO">LAKE ST LOUIS MO</option> <option data-id="42000298181" value="LAWRENCEVILLE">LAWRENCEVILLE</option> <option data-id="42000347730" value="MACHESNEY PARK">MACHESNEY PARK</option> <option data-id="42000298182" value="MAHOMET">MAHOMET</option> <option data-id="42000298183" value="MANSFIELD">MANSFIELD</option> <option data-id="42000298184" value="MARION">MARION</option> <option data-id="42000298185" value="MARSHALL">MARSHALL</option> <option data-id="42000298186" value="MARTINSVILLE">MARTINSVILLE</option> <option data-id="42000298187" value="MATTOON CROSS COUNTY">MATTOON CROSS COUNTY</option> <option data-id="42000298188" value="MATTOON DRIVES">MATTOON DRIVES</option> <option data-id="42000298189" value="MATTOON MAIN (CHARLESTON AVE)">MATTOON MAIN (CHARLESTON AVE)</option> <option data-id="42000347731" value="MCHENRY">MCHENRY</option> <option data-id="42000298190" value="MONTICELLO">MONTICELLO</option> <option data-id="42000298191" value="MT CARMEL">MT CARMEL</option> <option data-id="42000298192" value="MT VERNON">MT VERNON</option> <option data-id="42000298193" value="MURPHYSBORO">MURPHYSBORO</option> <option data-id="42000298194" value="NEOGA">NEOGA</option> <option data-id="42000325997" value="O'FALLON MO">O'FALLON MO</option> <option data-id="42000298195" value="OSAGE BEACH MO">OSAGE BEACH MO</option> <option data-id="42000298196" value="PARIS">PARIS</option> <option data-id="42000298197" value="PEORIA ADAMS">PEORIA ADAMS</option> <option data-id="42000298198" value="PEORIA KNOXVILLE">PEORIA KNOXVILLE</option> <option data-id="42000298199" value="PEORIA STERLING">PEORIA STERLING</option> <option data-id="42000298200" value="PEORIA UNIVERSITY">PEORIA UNIVERSITY</option> <option data-id="42000298201" value="QUINCY MAIN">QUINCY MAIN</option> <option data-id="42000298202" value="QUINCY MALL">QUINCY MALL</option> <option data-id="42000298203" value="RANTOUL">RANTOUL</option> <option data-id="42000347732" value="ROCKFORD 11TH STREET">ROCKFORD 11TH STREET</option> <option data-id="42000347733" value="ROCKFORD PERRYVILLE">ROCKFORD PERRYVILLE</option> <option data-id="42000347734" value="ROSCOE">ROSCOE</option> <option data-id="42000298204" value="SAVOY">SAVOY</option> <option data-id="42000347735" value="ST CHARLES IL">ST CHARLES IL</option> <option data-id="42000298205" value="ST CHARLES MO">ST CHARLES MO</option> <option data-id="42000298206" value="ST LOUIS MO">ST LOUIS MO</option> <option data-id="42000325998" value="ST LOUIS MO MARKET STREET">ST LOUIS MO MARKET STREET</option> <option data-id="42000325999" value="ST LOUIS MO-SOUTHFIELD CTR">ST LOUIS MO-SOUTHFIELD CTR</option> <option data-id="42000298207" value="ST PETERS MO">ST PETERS MO</option> <option data-id="42000298208" value="SULLIVAN">SULLIVAN</option> <option data-id="42000298209" value="SWANSEA">SWANSEA</option> <option data-id="42000298210" value="TAYLORVILLE">TAYLORVILLE</option> <option data-id="42000298211" value="TUSCOLA">TUSCOLA</option> <option data-id="42000298212" value="URBANA">URBANA</option> <option data-id="42000298213" value="WELDON">WELDON</option> <option data-id="42000298214" value="WINFIELD MO">WINFIELD MO</option> <option data-id="42000298215" value="WOOD RIVER">WOOD RIVER</option></select> </div>
<label class=" control-label cf_notification_date_870937-label " for="helpdesk_ticket_cf_notification_date_870937">Date of Activity/Event/Request</label> <div class="controls support-date-field "> <input type="text" name="helpdesk_ticket[custom_field][cf_notification_date_870937]" id="helpdesk_ticket_custom_field_cf_notification_date_870937" class=" date section_field datepicker_popover" readonly="readonly" data-show-image="true" data-date-format="d M, yy" placeholder="" /> </div>
<label class=" control-label cf_customer_name_bsa_870937-label " for="helpdesk_ticket_cf_customer_name_bsa_870937">Name of Conductor/Requestor/Customer </label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_customer_name_bsa_870937]" id="helpdesk_ticket_custom_field_cf_customer_name_bsa_870937" /> </div>
<label class=" control-label cf_port_numbers_870937-label " for="helpdesk_ticket_cf_port_numbers_870937">Port Number(s)</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_port_numbers_870937]" id="helpdesk_ticket_custom_field_cf_port_numbers_870937" /> </div>
<label class=" control-label cf_account_870937-label " for="helpdesk_ticket_cf_account_870937">Account Number(s)</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_account_870937]" id="helpdesk_ticket_custom_field_cf_account_870937" /> </div>
<label class=" required control-label cf_buckets371848_870937-label " for="helpdesk_ticket_cf_buckets371848_870937">Buckets</label> <div class="controls nested_field "> <select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_buckets371848_870937_42000333620" name="helpdesk_ticket[custom_field][cf_buckets371848_870937]"><option value="">...</option> <option value="Cards">Cards</option> <option value="Card Orders">Card Orders</option> <option value="ATM Repair (Choose ATM Terminal)">ATM Repair (Choose ATM Terminal)</option> <option value="Trism">Trism</option> <option value="Director Unity">Director Unity</option> <option value="General Inquiry">General Inquiry</option> <option value="ATM Deposit Inquiry">ATM Deposit Inquiry</option></select><div class="level_2"><label class="required">Additional Info</label><select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_drop_down958127_870937_42000333620" name="helpdesk_ticket[custom_field][cf_drop_down958127_870937]"><option value="">...</option> </select></div><script> //<![CDATA[ jQuery('#helpdesk_ticket_custom_field_cf_buckets371848_870937_42000333620').nested_select_tag({"data_tree":[["Cards","Cards",[["Travel Notice Inquiry","Travel Notice Inquiry",[]],["General Inquiry","General Inquiry",[]]]],["Card Orders","Card Orders",[]],["ATM Repair (Choose ATM Terminal)","ATM Repair (Choose ATM Terminal)",[]],["Trism","Trism",[["Printer Inquiry","Printer Inquiry",[]],["Balancing Inquiry","Balancing Inquiry",[]],["EOD/EOM Reports","EOD/EOM Reports",[]],["User Access (Attach BVS Certificate)","User Access (Attach BVS Certificate)",[]]]],["Director Unity","Director Unity",[["User Access (Attach BVS Certificate)","User Access (Attach BVS Certificate)",[]],["General Inquiry","General Inquiry",[]]]],["General Inquiry","General Inquiry",[]],["ATM Deposit Inquiry","ATM Deposit Inquiry",[]]],"initValues":null,"disable_children":false,"include_blank":"...","selected":null,"pl_value_id":"42000333620","subcategory_id":"helpdesk_ticket_custom_field_cf_drop_down958127_870937_42000333620"}); //]]> </script> </div>
<label class=" control-label cf_card_number_870937-label " for="helpdesk_ticket_cf_card_number_870937">Card Number</label> <div class="controls "> <input class=" number section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_card_number_870937]" id="helpdesk_ticket_custom_field_cf_card_number_870937" /> </div>
<label class=" control-label cf_old_card_number_870937-label " for="helpdesk_ticket_cf_old_card_number_870937">Old Card Number</label> <div class="controls "> <input class=" number section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_old_card_number_870937]" id="helpdesk_ticket_custom_field_cf_old_card_number_870937" /> </div>
<label class=" control-label cf_csatm_terminal_870937-label " for="helpdesk_ticket_cf_csatm_terminal_870937">ATM Terminal</label> <div class="controls "> <select class=" dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_csatm_terminal_870937]" id="helpdesk_ticket_custom_field_cf_csatm_terminal_870937"><option value="">...</option> <option data-id="42000332887" value="IL001689-ALTAMONT">IL001689-ALTAMONT</option> <option data-id="42000332888" value="IL001690-ALTON">IL001690-ALTON</option> <option data-id="42000332889" value="IL001691-ARCOLA">IL001691-ARCOLA</option> <option data-id="42000332890" value="IL001692- BARTONVILLE">IL001692- BARTONVILLE</option> <option data-id="42000332891" value="IL001693- BLOOMINGTON">IL001693- BLOOMINGTON</option> <option data-id="42000332892" value="IL001694- CARBONDALE LAUNDRY">IL001694- CARBONDALE LAUNDRY</option> <option data-id="42000332893" value="IL001695-CARBONDALE MAIN - DRIVE UP">IL001695-CARBONDALE MAIN - DRIVE UP</option> <option data-id="42000332894" value="IL001696-CARBONDALE MAIN - WALK UP">IL001696-CARBONDALE MAIN - WALK UP</option> <option data-id="42000332895" value="IL001698- CARBONDALE SCHNUCKS">IL001698- CARBONDALE SCHNUCKS</option> <option data-id="42000332896" value="IL001699- CARBONDALE SIU">IL001699- CARBONDALE SIU</option> <option data-id="42000332897" value="IL001700-CARMI">IL001700-CARMI</option> <option data-id="42000332898" value="IL001701-CARTERVILLE">IL001701-CARTERVILLE</option> <option data-id="42000332899" value="IL001702-CHAMPAIGN CHURCH">IL001702-CHAMPAIGN CHURCH</option> <option data-id="42000332900" value="IL001704- CHAMPAIGN MARKETVIEW">IL001704- CHAMPAIGN MARKETVIEW</option> <option data-id="42000332901" value="IL001705- CHARLESTON 4TH STREET">IL001705- CHARLESTON 4TH STREET</option> <option data-id="42000332902" value="IL001706-CHARLESTON 6th ST">IL001706-CHARLESTON 6th ST</option> <option data-id="42000332903" value="IL001707-CHARLESTON LINCOLN">IL001707-CHARLESTON LINCOLN</option> <option data-id="42000332904" value="IL001708- CHRISMAN">IL001708- CHRISMAN</option> <option data-id="42000332905" value="IL001709-DECATUR AIRPORT Rt 36">IL001709-DECATUR AIRPORT Rt 36</option> <option data-id="42000332906" value="IL001712-DECATUR N MAIN">IL001712-DECATUR N MAIN</option> <option data-id="42000332907" value="IL001713-DECATUR PERSHING">IL001713-DECATUR PERSHING</option> <option data-id="42000332908" value="IL001714-DESOTO">IL001714-DESOTO</option> <option data-id="42000332909" value="IL001715-EDWARDSVILLE CENTER GROVE">IL001715-EDWARDSVILLE CENTER GROVE</option> <option data-id="42000332910" value="IL001716-EDWARDSVILLE GOSHEN">IL001716-EDWARDSVILLE GOSHEN</option> <option data-id="42000332911" value="IL001717-EDWARDSVILLE RT 157">IL001717-EDWARDSVILLE RT 157</option> <option data-id="42000332912" value="IL001718-EDWARDSVILLE ST LOUIS">IL001718-EDWARDSVILLE ST LOUIS</option> <option data-id="42000332913" value="IL001719- EFFINGHAM">IL001719- EFFINGHAM</option> <option data-id="42000332914" value="IL001720-FORSYTH">IL001720-FORSYTH</option> <option data-id="42000332915" value="IL001721-GALESBURG HENDERSON">IL001721-GALESBURG HENDERSON</option> <option data-id="42000332916" value="IL001722-GALESBURG MAIN">IL001722-GALESBURG MAIN</option> <option data-id="42000332917" value="IL001723-HARRISBURG MAIN">IL001723-HARRISBURG MAIN</option> <option data-id="42000332918" value="IL001724-HARRISBURG SOUTH">IL001724-HARRISBURG SOUTH</option> <option data-id="42000332919" value="IL001725-HIGHLAND">IL001725-HIGHLAND</option> <option data-id="42000332920" value="IL001727-KNOXVILLE">IL001727-KNOXVILLE</option> <option data-id="42000332921" value="IL001728-LAWRENCEVILLE">IL001728-LAWRENCEVILLE</option> <option data-id="42000332922" value="IL001729- MAHOMET">IL001729- MAHOMET</option> <option data-id="42000332923" value="IL001730- MANSFIELD">IL001730- MANSFIELD</option> <option data-id="42000332924" value="IL001731-MARION">IL001731-MARION</option> <option data-id="42000332925" value="IL001732-MARSHALL">IL001732-MARSHALL</option> <option data-id="42000332926" value="IL001733- MARSHALL MARATHON">IL001733- MARSHALL MARATHON</option> <option data-id="42000332927" value="IL001734- MARTINSVILLE">IL001734- MARTINSVILLE</option> <option data-id="42000332928" value="IL001735-MATTOON CCF">IL001735-MATTOON CCF</option> <option data-id="42000332929" value="IL001736- MATTOON MAIN">IL001736- MATTOON MAIN</option> <option data-id="42000332930" value="IL001738-MATTOON DRIVES">IL001738-MATTOON DRIVES</option> <option data-id="42000332931" value="IL001739- MATTOON LAKELAND">IL001739- MATTOON LAKELAND</option> <option data-id="42000332932" value="IL001740- MATTOON LL COLLEGE">IL001740- MATTOON LL COLLEGE</option> <option data-id="42000332933" value="IL001741- MATTOON MASONIC">IL001741- MATTOON MASONIC</option> <option data-id="42000332934" value="IL001742- MATTOON SBLHC">IL001742- MATTOON SBLHC</option> <option data-id="42000332935" value="IL001743-MONTICELLO">IL001743-MONTICELLO</option> <option data-id="42000332936" value="IL001744-MT. CARMEL">IL001744-MT. CARMEL</option> <option data-id="42000332937" value="IL001745-MT. VERNON">IL001745-MT. VERNON</option> <option data-id="42000332938" value="IL001746-MURPHYSBORO">IL001746-MURPHYSBORO</option> <option data-id="42000332939" value="IL001747-NEOGA">IL001747-NEOGA</option> <option data-id="42000332940" value="IL001748-PARIS">IL001748-PARIS</option> <option data-id="42000332941" value="IL001749- PARIS EAST">IL001749- PARIS EAST</option> <option data-id="42000332942" value="IL001750- PARIS WEST">IL001750- PARIS WEST</option> <option data-id="42000332943" value="IL001751-PEORIA ADAMS">IL001751-PEORIA ADAMS</option> <option data-id="42000332944" value="IL001752-PEORIA BIRD">IL001752-PEORIA BIRD</option> <option data-id="42000332945" value="IL001754- PEORIA UNIVERSITY">IL001754- PEORIA UNIVERSITY</option> <option data-id="42000332946" value="IL001755-QUINCY BRDWY">IL001755-QUINCY BRDWY</option> <option data-id="42000332947" value="IL001756-QUINCY HAMPSHIRE">IL001756-QUINCY HAMPSHIRE</option> <option data-id="42000332948" value="IL001757- RANTOUL">IL001757- RANTOUL</option> <option data-id="42000332949" value="IL001758- SAVOY">IL001758- SAVOY</option> <option data-id="42000332950" value="IL001759-SULLIVAN">IL001759-SULLIVAN</option> <option data-id="42000332951" value="IL001760- SULLIVAN IGA">IL001760- SULLIVAN IGA</option> <option data-id="42000332952" value="IL001762-TAYLORVILLE">IL001762-TAYLORVILLE</option> <option data-id="42000332953" value="IL001763-TUSCOLA">IL001763-TUSCOLA</option> <option data-id="42000332954" value="IL001764- URBANA">IL001764- URBANA</option> <option data-id="42000332955" value="IL001766-WOOD RIVER">IL001766-WOOD RIVER</option> <option data-id="42000332956" value="IL001880-CHARLESTON SBLHC">IL001880-CHARLESTON SBLHC</option> <option data-id="42000332957" value="IL001917-FAIRVIEW HEIGHTS">IL001917-FAIRVIEW HEIGHTS</option> <option data-id="42000332958" value="IL001983- BCBS BUILDING">IL001983- BCBS BUILDING</option> <option data-id="42000332959" value="MO000870-CLAYTON">MO000870-CLAYTON</option> <option data-id="42000332960" value="MO000924-ELSBERRY">MO000924-ELSBERRY</option> <option data-id="42000332961" value="MO000925-WINFIELD">MO000925-WINFIELD</option> <option data-id="42000332962" value="MO000926-ST PETERS">MO000926-ST PETERS</option> <option data-id="42000332963" value="MO000927- COLUMBIA FORUM">MO000927- COLUMBIA FORUM</option> <option data-id="42000332964" value="MO000928-COLUMBIA 5TH STREET">MO000928-COLUMBIA 5TH STREET</option> <option data-id="42000332965" value="MO000929-OSAGE BEACH">MO000929-OSAGE BEACH</option> <option data-id="42000332966" value="MO000931-ST LOUIS JEFFERSON">MO000931-ST LOUIS JEFFERSON</option> <option data-id="42000332967" value="MO000932-ST CHARLES">MO000932-ST CHARLES</option> <option data-id="42000332968" value="MO000933-JEFFERSON CITY STADIUM">MO000933-JEFFERSON CITY STADIUM</option> <option data-id="42000332969" value="MO000934-JEFFERSON CITY ELLIS">MO000934-JEFFERSON CITY ELLIS</option> <option data-id="42000332970" value="MO000935-JEFFERSON CITY MISSOURI WILDWOOD">MO000935-JEFFERSON CITY MISSOURI WILDWOOD</option> <option data-id="42000332971" value="MO000936- JEFF CITY - LINCOLN UNIVERSITY">MO000936- JEFF CITY - LINCOLN UNIVERSITY</option> <option data-id="42000332972" value="MO000939-LAKE ST LOUIS">MO000939-LAKE ST LOUIS</option> <option data-id="42000332973" value="MO000972-CREVE COEUR">MO000972-CREVE COEUR</option> <option data-id="42000332974" value="MO000973-EUREKA">MO000973-EUREKA</option> <option data-id="42000332975" value="MO000974- O'FALLON">MO000974- O'FALLON</option> <option data-id="42000332976" value="MO000975-ST LOUIS MARKET">MO000975-ST LOUIS MARKET</option> <option data-id="42000332977" value="MO000976-ST LOUIS SOUTHFIELD">MO000976-ST LOUIS SOUTHFIELD</option> <option data-id="42000354768" value="WI001371 – BELOIT BROAD">WI001371 – BELOIT BROAD</option> <option data-id="42000354769" value="IL002050 – BELVIDERE (NUSOURCE)">IL002050 – BELVIDERE (NUSOURCE)</option> <option data-id="42000354770" value="IL002049 – MACHESNEY PARK">IL002049 – MACHESNEY PARK</option> <option data-id="42000354771" value="IL002047 – MCHENRY">IL002047 – MCHENRY</option> <option data-id="42000354772" value="IL002046 – ROCKFORD – 11TH ST">IL002046 – ROCKFORD – 11TH ST</option> <option data-id="42000354773" value="IL002045 – ROCKFORD PERRYVILLE">IL002045 – ROCKFORD PERRYVILLE</option> <option data-id="42000354774" value="IL002048 – ROSCOE">IL002048 – ROSCOE</option> <option data-id="42000354775" value="IL002051 – ST CHARLES, IL (NUSOURCE)">IL002051 – ST CHARLES, IL (NUSOURCE)</option> <option data-id="42000354776" value="MEIRTRAN – BELOIT CRANSTON">MEIRTRAN – BELOIT CRANSTON</option> <option data-id="42000354777" value="MEIRTRAN – JANESVILLE">MEIRTRAN – JANESVILLE</option></select> </div>
<label class=" control-label cf_branch374263_870937-label " for="helpdesk_ticket_cf_branch374263_870937">Branch</label> <div class="controls "> <select class=" dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_branch374263_870937]" id="helpdesk_ticket_custom_field_cf_branch374263_870937"><option value="">...</option> <option data-id="42000332411" value="ALTAMONT (9)">ALTAMONT (9)</option> <option data-id="42000332412" value="ALTON (28)">ALTON (28)</option> <option data-id="42000332413" value="ARCOLA (10)">ARCOLA (10)</option> <option data-id="42000332414" value="BARTONVILLE (26)">BARTONVILLE (26)</option> <option data-id="42000347686" value="BELOIT BROAD (77)">BELOIT BROAD (77)</option> <option data-id="42000347688" value="BELOIT CRANSTON (79)">BELOIT CRANSTON (79)</option> <option data-id="42000347694" value="BELVIDERE (85)">BELVIDERE (85)</option> <option data-id="42000332415" value="BLOOMINGTON (53)">BLOOMINGTON (53)</option> <option data-id="42000332416" value="CARBONDALE (39)">CARBONDALE (39)</option> <option data-id="42000332417" value="CARBONDALE SCHNUCKS (39)">CARBONDALE SCHNUCKS (39)</option> <option data-id="42000332418" value="CARMI (33)">CARMI (33)</option> <option data-id="42000332419" value="CARMI DRIVES (33)">CARMI DRIVES (33)</option> <option data-id="42000332420" value="CARTERVILLE (38)">CARTERVILLE (38)</option> <option data-id="42000332421" value="CHAMPAIGN CHURCH (44)">CHAMPAIGN CHURCH (44)</option> <option data-id="42000332422" value="CHAMPAIGN MARKETVIEW (7)">CHAMPAIGN MARKETVIEW (7)</option> <option data-id="42000332423" value="CHARLESTON (6)">CHARLESTON (6)</option> <option data-id="42000332424" value="CLAYTON (43)">CLAYTON (43)</option> <option data-id="42000332425" value="COLMBIA MO-FORUM (56)">COLMBIA MO-FORUM (56)</option> <option data-id="42000332426" value="COLUMBIA MO-5TH (57)">COLUMBIA MO-5TH (57)</option> <option data-id="42000332427" value="CREVE COEUR MO (74)">CREVE COEUR MO (74)</option> <option data-id="42000332428" value="DECATUR AIRPORT (50)">DECATUR AIRPORT (50)</option> <option data-id="42000332429" value="DECATUR FORSYTH (50)">DECATUR FORSYTH (50)</option> <option data-id="42000332430" value="DECATUR NORTH MAIN (50)">DECATUR NORTH MAIN (50)</option> <option data-id="42000332431" value="DECATUR PERSHING (50)">DECATUR PERSHING (50)</option> <option data-id="42000332433" value="EDWARDSVILLE GOSHEN (40)">EDWARDSVILLE GOSHEN (40)</option> <option data-id="42000332434" value="EDWARDSVILLE 157 (40)">EDWARDSVILLE 157 (40)</option> <option data-id="42000332435" value="EDWARDSVILLE ST LOUIS ST (40)">EDWARDSVILLE ST LOUIS ST (40)</option> <option data-id="42000332436" value="EFFINGHAM (8)">EFFINGHAM (8)</option> <option data-id="42000332437" value="ELSBERRY MO (59)">ELSBERRY MO (59)</option> <option data-id="42000332438" value="EUREKA MO (75)">EUREKA MO (75)</option> <option data-id="42000332439" value="FAIRVIEW HEIGHTS (55)">FAIRVIEW HEIGHTS (55)</option> <option data-id="42000332440" value="GALESBURG HENDERSON (23)">GALESBURG HENDERSON (23)</option> <option data-id="42000332441" value="GALESBURG MAIN (23)">GALESBURG MAIN (23)</option> <option data-id="42000332442" value="GRAPEVINE TX (69)">GRAPEVINE TX (69)</option> <option data-id="42000332443" value="HARRISBURG MAIN (37)">HARRISBURG MAIN (37)</option> <option data-id="42000332444" value="HARRISBURG SOUTH (37)">HARRISBURG SOUTH (37)</option> <option data-id="42000332445" value="HIGHLAND (17)">HIGHLAND (17)</option> <option data-id="42000347687" value="JANESVILLE WI (78)">JANESVILLE WI (78)</option> <option data-id="42000332446" value="JEFFERSON MO - MISSOURI (62)">JEFFERSON MO - MISSOURI (62)</option> <option data-id="42000332447" value="JEFFERSON MO-ELLIS (63)">JEFFERSON MO-ELLIS (63)</option> <option data-id="42000332448" value="JEFFERSON MO-STADIUM (61)">JEFFERSON MO-STADIUM (61)</option> <option data-id="42000332449" value="KNOXVILLE (23)">KNOXVILLE (23)</option> <option data-id="42000332450" value="LAKE ST LOUIS MO (65)">LAKE ST LOUIS MO (65)</option> <option data-id="42000332451" value="LAWRENCEVILLE (30)">LAWRENCEVILLE (30)</option> <option data-id="42000347689" value="MACHESNEY PARK (80)">MACHESNEY PARK (80)</option> <option data-id="42000332452" value="MAHOMET (20)">MAHOMET (20)</option> <option data-id="42000332453" value="MANSFIELD (19)">MANSFIELD (19)</option> <option data-id="42000332454" value="MARION (36)">MARION (36)</option> <option data-id="42000332455" value="MARSHALL (46)">MARSHALL (46)</option> <option data-id="42000332456" value="MATTOON CROSS COUNTRY (3)">MATTOON CROSS COUNTRY (3)</option> <option data-id="42000332457" value="MATTOON MAIN (3)">MATTOON MAIN (3)</option> <option data-id="42000332458" value="MATTOON DRIVES (3)">MATTOON DRIVES (3)</option> <option data-id="42000347695" value="MCHENRY (86)">MCHENRY (86)</option> <option data-id="42000332459" value="MONTICELLO (14)">MONTICELLO (14)</option> <option data-id="42000332460" value="MT CARMEL (31)">MT CARMEL (31)</option> <option data-id="42000332461" value="MT VERNON (32)">MT VERNON (32)</option> <option data-id="42000332462" value="MURPHYSBORO (35)">MURPHYSBORO (35)</option> <option data-id="42000332463" value="NEOGA (4)">NEOGA (4)</option> <option data-id="42000332464" value="O'FALLON MO (76)">O'FALLON MO (76)</option> <option data-id="42000332465" value="OSAGE BEACH MO (64)">OSAGE BEACH MO (64)</option> <option data-id="42000332466" value="PARIS (45)">PARIS (45)</option> <option data-id="42000332467" value="PARIS DRIVES (45)">PARIS DRIVES (45)</option> <option data-id="42000332468" value="PEORIA ADAMS (22)">PEORIA ADAMS (22)</option> <option data-id="42000332469" value="PEORIA BIRD (22)">PEORIA BIRD (22)</option> <option data-id="42000332470" value="PEORIA UNIVERSITY (52)">PEORIA UNIVERSITY (52)</option> <option data-id="42000332471" value="QUINCY MAIN (25)">QUINCY MAIN (25)</option> <option data-id="42000332472" value="QUINCY MALL (25)">QUINCY MALL (25)</option> <option data-id="42000332473" value="RANTOUL (48)">RANTOUL (48)</option> <option data-id="42000347691" value="ROCKFORD 11TH STREET (82)">ROCKFORD 11TH STREET (82)</option> <option data-id="42000347692" value="ROCKFORD PERRYVILLE (83)">ROCKFORD PERRYVILLE (83)</option> <option data-id="42000347690" value="ROSCOE (81)">ROSCOE (81)</option> <option data-id="42000332474" value="SAVOY (49)">SAVOY (49)</option> <option data-id="42000347693" value="ST CHARLES IL (84)">ST CHARLES IL (84)</option> <option data-id="42000332475" value="ST CHARLES MO (66)">ST CHARLES MO (66)</option> <option data-id="42000332476" value="ST LOUIS MO (68)">ST LOUIS MO (68)</option> <option data-id="42000332477" value="ST LOUIS MO-MARKET ST (72)">ST LOUIS MO-MARKET ST (72)</option> <option data-id="42000332478" value="ST LOUIS MO-SOUTHFIELD CTR (73)">ST LOUIS MO-SOUTHFIELD CTR (73)</option> <option data-id="42000332479" value="ST PETERS MO (67)">ST PETERS MO (67)</option> <option data-id="42000332480" value="SULLIVAN (2)">SULLIVAN (2)</option> <option data-id="42000332481" value="TAYLORVILLE (15)">TAYLORVILLE (15)</option> <option data-id="42000332482" value="TUSCOLA (5)">TUSCOLA (5)</option> <option data-id="42000332483" value="URBANA (7)">URBANA (7)</option> <option data-id="42000332484" value="WINFIELD MO (60)">WINFIELD MO (60)</option> <option data-id="42000332485" value="WOOD RIVER (41)">WOOD RIVER (41)</option></select> </div>
<label class=" control-label cf_call_back_number911563_870937-label " for="helpdesk_ticket_cf_call_back_number911563_870937">Call Back Number</label> <div class="controls "> <input class=" number section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_call_back_number911563_870937]" id="helpdesk_ticket_custom_field_cf_call_back_number911563_870937" /> </div>
<label class=" control-label cf_productservice_870937-label " for="helpdesk_ticket_cf_productservice_870937">Product/Service</label> <div class="controls nested_field "> <select class=" nested_field section_field" id="helpdesk_ticket_custom_field_cf_productservice_870937_42000329270" name="helpdesk_ticket[custom_field][cf_productservice_870937]"><option value="">...</option> <option value="ATM">ATM</option> <option value="Armored Services">Armored Services</option> <option value="General Inquiry">General Inquiry</option></select><div class="level_2"><label class="">Issue Type</label><select class=" nested_field section_field" id="helpdesk_ticket_custom_field_cf_issue_type_870937_42000329270" name="helpdesk_ticket[custom_field][cf_issue_type_870937]"><option value="">...</option> </select></div><script> //<![CDATA[ jQuery('#helpdesk_ticket_custom_field_cf_productservice_870937_42000329270').nested_select_tag({"data_tree":[["ATM","ATM",[["Balancing","Balancing",[]],["Service Issue","Service Issue",[]],["General Inquiry","General Inquiry",[]]]],["Armored Services","Armored Services",[["Place emergency order/manual order","Place emergency order/manual order",[]],["Edit or cancel order","Edit or cancel order",[]],["Order not received or received partial order","Order not received or received partial order",[]],["Missed Service","Missed Service",[]],["Balancing questions / issues","Balancing questions / issues",[]],["User Changes","User Changes",[]],["Other","Other",[]]]],["General Inquiry","General Inquiry",[]]],"initValues":null,"disable_children":false,"include_blank":"...","selected":null,"pl_value_id":"42000329270","subcategory_id":"helpdesk_ticket_custom_field_cf_issue_type_870937_42000329270"}); //]]> </script> </div>
<label class=" control-label cf_branch374263_870937-label " for="helpdesk_ticket_cf_branch374263_870937">Branch</label> <div class="controls "> <select class=" dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_branch374263_870937]" id="helpdesk_ticket_custom_field_cf_branch374263_870937"><option value="">...</option> <option data-id="42000332411" value="ALTAMONT (9)">ALTAMONT (9)</option> <option data-id="42000332412" value="ALTON (28)">ALTON (28)</option> <option data-id="42000332413" value="ARCOLA (10)">ARCOLA (10)</option> <option data-id="42000332414" value="BARTONVILLE (26)">BARTONVILLE (26)</option> <option data-id="42000347686" value="BELOIT BROAD (77)">BELOIT BROAD (77)</option> <option data-id="42000347688" value="BELOIT CRANSTON (79)">BELOIT CRANSTON (79)</option> <option data-id="42000347694" value="BELVIDERE (85)">BELVIDERE (85)</option> <option data-id="42000332415" value="BLOOMINGTON (53)">BLOOMINGTON (53)</option> <option data-id="42000332416" value="CARBONDALE (39)">CARBONDALE (39)</option> <option data-id="42000332417" value="CARBONDALE SCHNUCKS (39)">CARBONDALE SCHNUCKS (39)</option> <option data-id="42000332418" value="CARMI (33)">CARMI (33)</option> <option data-id="42000332419" value="CARMI DRIVES (33)">CARMI DRIVES (33)</option> <option data-id="42000332420" value="CARTERVILLE (38)">CARTERVILLE (38)</option> <option data-id="42000332421" value="CHAMPAIGN CHURCH (44)">CHAMPAIGN CHURCH (44)</option> <option data-id="42000332422" value="CHAMPAIGN MARKETVIEW (7)">CHAMPAIGN MARKETVIEW (7)</option> <option data-id="42000332423" value="CHARLESTON (6)">CHARLESTON (6)</option> <option data-id="42000332424" value="CLAYTON (43)">CLAYTON (43)</option> <option data-id="42000332425" value="COLMBIA MO-FORUM (56)">COLMBIA MO-FORUM (56)</option> <option data-id="42000332426" value="COLUMBIA MO-5TH (57)">COLUMBIA MO-5TH (57)</option> <option data-id="42000332427" value="CREVE COEUR MO (74)">CREVE COEUR MO (74)</option> <option data-id="42000332428" value="DECATUR AIRPORT (50)">DECATUR AIRPORT (50)</option> <option data-id="42000332429" value="DECATUR FORSYTH (50)">DECATUR FORSYTH (50)</option> <option data-id="42000332430" value="DECATUR NORTH MAIN (50)">DECATUR NORTH MAIN (50)</option> <option data-id="42000332431" value="DECATUR PERSHING (50)">DECATUR PERSHING (50)</option> <option data-id="42000332433" value="EDWARDSVILLE GOSHEN (40)">EDWARDSVILLE GOSHEN (40)</option> <option data-id="42000332434" value="EDWARDSVILLE 157 (40)">EDWARDSVILLE 157 (40)</option> <option data-id="42000332435" value="EDWARDSVILLE ST LOUIS ST (40)">EDWARDSVILLE ST LOUIS ST (40)</option> <option data-id="42000332436" value="EFFINGHAM (8)">EFFINGHAM (8)</option> <option data-id="42000332437" value="ELSBERRY MO (59)">ELSBERRY MO (59)</option> <option data-id="42000332438" value="EUREKA MO (75)">EUREKA MO (75)</option> <option data-id="42000332439" value="FAIRVIEW HEIGHTS (55)">FAIRVIEW HEIGHTS (55)</option> <option data-id="42000332440" value="GALESBURG HENDERSON (23)">GALESBURG HENDERSON (23)</option> <option data-id="42000332441" value="GALESBURG MAIN (23)">GALESBURG MAIN (23)</option> <option data-id="42000332442" value="GRAPEVINE TX (69)">GRAPEVINE TX (69)</option> <option data-id="42000332443" value="HARRISBURG MAIN (37)">HARRISBURG MAIN (37)</option> <option data-id="42000332444" value="HARRISBURG SOUTH (37)">HARRISBURG SOUTH (37)</option> <option data-id="42000332445" value="HIGHLAND (17)">HIGHLAND (17)</option> <option data-id="42000347687" value="JANESVILLE WI (78)">JANESVILLE WI (78)</option> <option data-id="42000332446" value="JEFFERSON MO - MISSOURI (62)">JEFFERSON MO - MISSOURI (62)</option> <option data-id="42000332447" value="JEFFERSON MO-ELLIS (63)">JEFFERSON MO-ELLIS (63)</option> <option data-id="42000332448" value="JEFFERSON MO-STADIUM (61)">JEFFERSON MO-STADIUM (61)</option> <option data-id="42000332449" value="KNOXVILLE (23)">KNOXVILLE (23)</option> <option data-id="42000332450" value="LAKE ST LOUIS MO (65)">LAKE ST LOUIS MO (65)</option> <option data-id="42000332451" value="LAWRENCEVILLE (30)">LAWRENCEVILLE (30)</option> <option data-id="42000347689" value="MACHESNEY PARK (80)">MACHESNEY PARK (80)</option> <option data-id="42000332452" value="MAHOMET (20)">MAHOMET (20)</option> <option data-id="42000332453" value="MANSFIELD (19)">MANSFIELD (19)</option> <option data-id="42000332454" value="MARION (36)">MARION (36)</option> <option data-id="42000332455" value="MARSHALL (46)">MARSHALL (46)</option> <option data-id="42000332456" value="MATTOON CROSS COUNTRY (3)">MATTOON CROSS COUNTRY (3)</option> <option data-id="42000332457" value="MATTOON MAIN (3)">MATTOON MAIN (3)</option> <option data-id="42000332458" value="MATTOON DRIVES (3)">MATTOON DRIVES (3)</option> <option data-id="42000347695" value="MCHENRY (86)">MCHENRY (86)</option> <option data-id="42000332459" value="MONTICELLO (14)">MONTICELLO (14)</option> <option data-id="42000332460" value="MT CARMEL (31)">MT CARMEL (31)</option> <option data-id="42000332461" value="MT VERNON (32)">MT VERNON (32)</option> <option data-id="42000332462" value="MURPHYSBORO (35)">MURPHYSBORO (35)</option> <option data-id="42000332463" value="NEOGA (4)">NEOGA (4)</option> <option data-id="42000332464" value="O'FALLON MO (76)">O'FALLON MO (76)</option> <option data-id="42000332465" value="OSAGE BEACH MO (64)">OSAGE BEACH MO (64)</option> <option data-id="42000332466" value="PARIS (45)">PARIS (45)</option> <option data-id="42000332467" value="PARIS DRIVES (45)">PARIS DRIVES (45)</option> <option data-id="42000332468" value="PEORIA ADAMS (22)">PEORIA ADAMS (22)</option> <option data-id="42000332469" value="PEORIA BIRD (22)">PEORIA BIRD (22)</option> <option data-id="42000332470" value="PEORIA UNIVERSITY (52)">PEORIA UNIVERSITY (52)</option> <option data-id="42000332471" value="QUINCY MAIN (25)">QUINCY MAIN (25)</option> <option data-id="42000332472" value="QUINCY MALL (25)">QUINCY MALL (25)</option> <option data-id="42000332473" value="RANTOUL (48)">RANTOUL (48)</option> <option data-id="42000347691" value="ROCKFORD 11TH STREET (82)">ROCKFORD 11TH STREET (82)</option> <option data-id="42000347692" value="ROCKFORD PERRYVILLE (83)">ROCKFORD PERRYVILLE (83)</option> <option data-id="42000347690" value="ROSCOE (81)">ROSCOE (81)</option> <option data-id="42000332474" value="SAVOY (49)">SAVOY (49)</option> <option data-id="42000347693" value="ST CHARLES IL (84)">ST CHARLES IL (84)</option> <option data-id="42000332475" value="ST CHARLES MO (66)">ST CHARLES MO (66)</option> <option data-id="42000332476" value="ST LOUIS MO (68)">ST LOUIS MO (68)</option> <option data-id="42000332477" value="ST LOUIS MO-MARKET ST (72)">ST LOUIS MO-MARKET ST (72)</option> <option data-id="42000332478" value="ST LOUIS MO-SOUTHFIELD CTR (73)">ST LOUIS MO-SOUTHFIELD CTR (73)</option> <option data-id="42000332479" value="ST PETERS MO (67)">ST PETERS MO (67)</option> <option data-id="42000332480" value="SULLIVAN (2)">SULLIVAN (2)</option> <option data-id="42000332481" value="TAYLORVILLE (15)">TAYLORVILLE (15)</option> <option data-id="42000332482" value="TUSCOLA (5)">TUSCOLA (5)</option> <option data-id="42000332483" value="URBANA (7)">URBANA (7)</option> <option data-id="42000332484" value="WINFIELD MO (60)">WINFIELD MO (60)</option> <option data-id="42000332485" value="WOOD RIVER (41)">WOOD RIVER (41)</option></select> </div>
<label class=" control-label cf_atm_terminal_id_870937-label " for="helpdesk_ticket_cf_atm_terminal_id_870937">ATM Terminal ID</label> <div class="controls "> <select class=" dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_atm_terminal_id_870937]" id="helpdesk_ticket_custom_field_cf_atm_terminal_id_870937"><option value="">...</option> <option data-id="42000331112" value="IL001689-ALTAMONT">IL001689-ALTAMONT</option> <option data-id="42000331113" value="IL001690-ALTON">IL001690-ALTON</option> <option data-id="42000331114" value="IL001691-ARCOLA">IL001691-ARCOLA</option> <option data-id="42000331115" value="IL001692- BARTONVILLE">IL001692- BARTONVILLE</option> <option data-id="42000331116" value="IL001693- BLOOMINGTON">IL001693- BLOOMINGTON</option> <option data-id="42000331117" value="IL001694- CARBONDALE LAUNDRY">IL001694- CARBONDALE LAUNDRY</option> <option data-id="42000331118" value="IL001695-CARBONDALE MAIN - DRIVE UP">IL001695-CARBONDALE MAIN - DRIVE UP</option> <option data-id="42000331119" value="IL001696-CARBONDALE MAIN - WALK UP">IL001696-CARBONDALE MAIN - WALK UP</option> <option data-id="42000331120" value="IL001698- CARBONDALE SCHNUCKS">IL001698- CARBONDALE SCHNUCKS</option> <option data-id="42000331121" value="IL001699- CARBONDALE SIU">IL001699- CARBONDALE SIU</option> <option data-id="42000331122" value="IL001700-CARMI">IL001700-CARMI</option> <option data-id="42000331123" value="IL001701-CARTERVILLE">IL001701-CARTERVILLE</option> <option data-id="42000331124" value="IL001702-CHAMPAIGN CHURCH">IL001702-CHAMPAIGN CHURCH</option> <option data-id="42000331125" value="IL001704- CHAMPAIGN MARKETVIEW">IL001704- CHAMPAIGN MARKETVIEW</option> <option data-id="42000331126" value="IL001705- CHARLESTON 4TH STREET">IL001705- CHARLESTON 4TH STREET</option> <option data-id="42000331127" value="IL001706-CHARLESTON 6th ST">IL001706-CHARLESTON 6th ST</option> <option data-id="42000331128" value="IL001707-CHARLESTON LINCOLN">IL001707-CHARLESTON LINCOLN</option> <option data-id="42000331129" value="IL001708- CHRISMAN">IL001708- CHRISMAN</option> <option data-id="42000331130" value="IL001709-DECATUR AIRPORT Rt 36">IL001709-DECATUR AIRPORT Rt 36</option> <option data-id="42000331131" value="IL001712-DECATUR N MAIN">IL001712-DECATUR N MAIN</option> <option data-id="42000331132" value="IL001713-DECATUR PERSHING">IL001713-DECATUR PERSHING</option> <option data-id="42000331133" value="IL001714-DESOTO">IL001714-DESOTO</option> <option data-id="42000331134" value="IL001715-EDWARDSVILLE CENTER GROVE">IL001715-EDWARDSVILLE CENTER GROVE</option> <option data-id="42000331135" value="IL001716-EDWARDSVILLE GOSHEN">IL001716-EDWARDSVILLE GOSHEN</option> <option data-id="42000331136" value="IL001717-EDWARDSVILLE RT 157">IL001717-EDWARDSVILLE RT 157</option> <option data-id="42000331137" value="IL001718-EDWARDSVILLE ST LOUIS">IL001718-EDWARDSVILLE ST LOUIS</option> <option data-id="42000331138" value="IL001719- EFFINGHAM">IL001719- EFFINGHAM</option> <option data-id="42000331139" value="IL001720-FORSYTH">IL001720-FORSYTH</option> <option data-id="42000331140" value="IL001721-GALESBURG HENDERSON">IL001721-GALESBURG HENDERSON</option> <option data-id="42000331141" value="IL001722-GALESBURG MAIN">IL001722-GALESBURG MAIN</option> <option data-id="42000331142" value="IL001723-HARRISBURG MAIN">IL001723-HARRISBURG MAIN</option> <option data-id="42000331143" value="IL001724-HARRISBURG SOUTH">IL001724-HARRISBURG SOUTH</option> <option data-id="42000331144" value="IL001725-HIGHLAND">IL001725-HIGHLAND</option> <option data-id="42000331145" value="IL001727-KNOXVILLE">IL001727-KNOXVILLE</option> <option data-id="42000331146" value="IL001728-LAWRENCEVILLE">IL001728-LAWRENCEVILLE</option> <option data-id="42000331147" value="IL001729- MAHOMET">IL001729- MAHOMET</option> <option data-id="42000331148" value="IL001730- MANSFIELD">IL001730- MANSFIELD</option> <option data-id="42000331149" value="IL001731-MARION">IL001731-MARION</option> <option data-id="42000331150" value="IL001732-MARSHALL">IL001732-MARSHALL</option> <option data-id="42000331151" value="IL001733- MARSHALL MARATHON">IL001733- MARSHALL MARATHON</option> <option data-id="42000331152" value="IL001734- MARTINSVILLE">IL001734- MARTINSVILLE</option> <option data-id="42000331153" value="IL001735-MATTOON CCF">IL001735-MATTOON CCF</option> <option data-id="42000331154" value="IL001736- MATTOON MAIN">IL001736- MATTOON MAIN</option> <option data-id="42000331155" value="IL001738-MATTOON DRIVES">IL001738-MATTOON DRIVES</option> <option data-id="42000331156" value="IL001739- MATTOON LAKELAND">IL001739- MATTOON LAKELAND</option> <option data-id="42000331157" value="IL001740- MATTOON LL COLLEGE">IL001740- MATTOON LL COLLEGE</option> <option data-id="42000331158" value="IL001741- MATTOON MASONIC">IL001741- MATTOON MASONIC</option> <option data-id="42000331159" value="IL001742- MATTOON SBLHC">IL001742- MATTOON SBLHC</option> <option data-id="42000331160" value="IL001743-MONTICELLO">IL001743-MONTICELLO</option> <option data-id="42000331161" value="IL001744-MT. CARMEL">IL001744-MT. CARMEL</option> <option data-id="42000331162" value="IL001745-MT. VERNON">IL001745-MT. VERNON</option> <option data-id="42000331163" value="IL001746-MURPHYSBORO">IL001746-MURPHYSBORO</option> <option data-id="42000331164" value="IL001747-NEOGA">IL001747-NEOGA</option> <option data-id="42000331165" value="IL001748-PARIS">IL001748-PARIS</option> <option data-id="42000331166" value="IL001749- PARIS EAST">IL001749- PARIS EAST</option> <option data-id="42000331167" value="IL001750- PARIS WEST">IL001750- PARIS WEST</option> <option data-id="42000331168" value="IL001751-PEORIA ADAMS">IL001751-PEORIA ADAMS</option> <option data-id="42000331169" value="IL001752-PEORIA BIRD">IL001752-PEORIA BIRD</option> <option data-id="42000331170" value="IL001754- PEORIA UNIVERSITY">IL001754- PEORIA UNIVERSITY</option> <option data-id="42000331171" value="IL001755-QUINCY BRDWY">IL001755-QUINCY BRDWY</option> <option data-id="42000331172" value="IL001756-QUINCY HAMPSHIRE">IL001756-QUINCY HAMPSHIRE</option> <option data-id="42000331173" value="IL001757- RANTOUL">IL001757- RANTOUL</option> <option data-id="42000331174" value="IL001758- SAVOY">IL001758- SAVOY</option> <option data-id="42000331175" value="IL001759-SULLIVAN">IL001759-SULLIVAN</option> <option data-id="42000331176" value="IL001760- SULLIVAN IGA">IL001760- SULLIVAN IGA</option> <option data-id="42000331177" value="IL001762-TAYLORVILLE">IL001762-TAYLORVILLE</option> <option data-id="42000331178" value="IL001763-TUSCOLA">IL001763-TUSCOLA</option> <option data-id="42000331179" value="IL001764- URBANA">IL001764- URBANA</option> <option data-id="42000331180" value="IL001766-WOOD RIVER">IL001766-WOOD RIVER</option> <option data-id="42000331181" value="IL001880-CHARLESTON SBLHC">IL001880-CHARLESTON SBLHC</option> <option data-id="42000331182" value="IL001917-FAIRVIEW HEIGHTS">IL001917-FAIRVIEW HEIGHTS</option> <option data-id="42000331183" value="IL001983- BCBS BUILDING">IL001983- BCBS BUILDING</option> <option data-id="42000331184" value="MO000870-CLAYTON">MO000870-CLAYTON</option> <option data-id="42000331185" value="MO000924-ELSBERRY">MO000924-ELSBERRY</option> <option data-id="42000331186" value="MO000925-WINFIELD">MO000925-WINFIELD</option> <option data-id="42000331187" value="MO000926-ST PETERS">MO000926-ST PETERS</option> <option data-id="42000331188" value="MO000927- COLUMBIA FORUM">MO000927- COLUMBIA FORUM</option> <option data-id="42000331189" value="MO000928-COLUMBIA 5TH STREET">MO000928-COLUMBIA 5TH STREET</option> <option data-id="42000331190" value="MO000929-OSAGE BEACH">MO000929-OSAGE BEACH</option> <option data-id="42000331191" value="MO000931-ST LOUIS JEFFERSON">MO000931-ST LOUIS JEFFERSON</option> <option data-id="42000331192" value="MO000932-ST CHARLES">MO000932-ST CHARLES</option> <option data-id="42000331193" value="MO000933-JEFFERSON CITY STADIUM">MO000933-JEFFERSON CITY STADIUM</option> <option data-id="42000331194" value="MO000934-JEFFERSON CITY ELLIS">MO000934-JEFFERSON CITY ELLIS</option> <option data-id="42000331195" value="MO000935-JEFFERSON CITY MISSOURI WILDWOOD">MO000935-JEFFERSON CITY MISSOURI WILDWOOD</option> <option data-id="42000331196" value="MO000936- JEFF CITY - LINCOLN UNIVERSITY">MO000936- JEFF CITY - LINCOLN UNIVERSITY</option> <option data-id="42000331197" value="MO000939-LAKE ST LOUIS">MO000939-LAKE ST LOUIS</option> <option data-id="42000331198" value="MO000972-CREVE COEUR">MO000972-CREVE COEUR</option> <option data-id="42000331199" value="MO000973-EUREKA">MO000973-EUREKA</option> <option data-id="42000331200" value="MO000975-ST LOUIS MARKET">MO000975-ST LOUIS MARKET</option> <option data-id="42000331201" value="MO000976-ST LOUIS SOUTHFIELD">MO000976-ST LOUIS SOUTHFIELD</option></select> </div>
<label class=" required control-label cf_call_back_number581483_870937-label " for="helpdesk_ticket_cf_call_back_number581483_870937">Call Back Number</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_call_back_number581483_870937]" id="helpdesk_ticket_custom_field_cf_call_back_number581483_870937" /> </div>
<label class=" control-label cf_callback_prefrence_870937-label " for="helpdesk_ticket_cf_callback_prefrence_870937">Callback Preference</label> <div class="controls "> <select class=" dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_callback_prefrence_870937]" id="helpdesk_ticket_custom_field_cf_callback_prefrence_870937"><option value="">...</option> <option data-id="42000055941" value="Phone">Phone</option> <option data-id="42000055943" value="Email">Email</option></select> </div>
<label class=" required control-label cf_name_870937-label " for="helpdesk_ticket_cf_name_870937">Name</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_name_870937]" id="helpdesk_ticket_custom_field_cf_name_870937" /> </div>
<label class=" control-label cf_phone_870937-label " for="helpdesk_ticket_cf_phone_870937">Phone</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_phone_870937]" id="helpdesk_ticket_custom_field_cf_phone_870937" /> </div>
<label class=" control-label cf_date_of_service_870937-label " for="helpdesk_ticket_cf_date_of_service_870937">Date of Service</label> <div class="controls support-date-field "> <input type="text" name="helpdesk_ticket[custom_field][cf_date_of_service_870937]" id="helpdesk_ticket_custom_field_cf_date_of_service_870937" class=" date section_field datepicker_popover" readonly="readonly" data-show-image="true" data-date-format="d M, yy" placeholder="" /> </div>
<label class=" required control-label cf_this_message_is_about_870937-label " for="helpdesk_ticket_cf_this_message_is_about_870937">Message Type</label> <div class="controls "> <select class=" required dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_this_message_is_about_870937]" id="helpdesk_ticket_custom_field_cf_this_message_is_about_870937"><option value="">...</option> <option data-id="42000055902" value="Compliment">Compliment</option> <option data-id="42000055903" value="Comment">Comment</option> <option data-id="42000055930" value="Question">Question</option> <option data-id="42000198956" value="Other">Other</option></select> </div>
<label class=" control-label cf_t_870937-label " for="helpdesk_ticket_cf_t_870937">This message pertains to:</label> <div class="controls "> <select class=" dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_t_870937]" id="helpdesk_ticket_custom_field_cf_t_870937"><option value="">...</option> <option data-id="42000055904" value="First Mid Banking Center">First Mid Banking Center</option> <option data-id="42000055905" value="First Mid Banking Overall">First Mid Banking Overall</option> <option data-id="42000055931" value="First Mid Employee">First Mid Employee</option> <option data-id="42000258489" value="First Mid Insurance Services">First Mid Insurance Services</option> <option data-id="42000258490" value="First Mid Wealth Management">First Mid Wealth Management</option> <option data-id="42000055932" value="Other">Other</option></select> </div>
<label class=" control-label cf_this_message_is_regarding_870937-label " for="helpdesk_ticket_cf_this_message_is_regarding_870937">This message is regarding:</label> <div class="controls "> <select class=" dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_this_message_is_regarding_870937]" id="helpdesk_ticket_custom_field_cf_this_message_is_regarding_870937"><option value="">...</option> <option data-id="42000055933" value="Bank Policies">Bank Policies</option> <option data-id="42000055934" value="Banking Products/Services">Banking Products/Services</option> <option data-id="42000055935" value="Cleanliness/Appearance of Bank Center">Cleanliness/Appearance of Bank Center</option> <option data-id="42000055936" value="Customer Service/Staff">Customer Service/Staff</option> <option data-id="42000055937" value="Hours of Operation">Hours of Operation</option> <option data-id="42000055939" value="Statements">Statements</option> <option data-id="42000055940" value="Other">Other</option></select> </div>
<label class=" required control-label cf_name_2_870937-label " for="helpdesk_ticket_cf_name_2_870937">Name </label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_name_2_870937]" id="helpdesk_ticket_custom_field_cf_name_2_870937" /> </div>
<label class=" required control-label cf_port_number_870937-label " for="helpdesk_ticket_cf_port_number_870937">Port #</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_port_number_870937]" id="helpdesk_ticket_custom_field_cf_port_number_870937" /> </div>
<label class=" required control-label cf_cust_name_870937-label " for="helpdesk_ticket_cf_cust_name_870937">Customer Name</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_cust_name_870937]" id="helpdesk_ticket_custom_field_cf_cust_name_870937" /> </div>
<label class=" control-label cf_customer_phone_870937-label " for="helpdesk_ticket_cf_customer_phone_870937">Customer Phone</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_customer_phone_870937]" id="helpdesk_ticket_custom_field_cf_customer_phone_870937" /> </div>
<label class=" required control-label cf_contact_2_870937-label " for="helpdesk_ticket_cf_contact_2_870937">Preferred Method of Contact</label> <div class="controls "> <select class=" required dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_contact_2_870937]" id="helpdesk_ticket_custom_field_cf_contact_2_870937"><option value="">...</option> <option data-id="42000254814" value="Telephone">Telephone</option> <option data-id="42000254815" value="Email">Email</option> <option data-id="42000258494" value="In Writing">In Writing</option></select> </div>
<label class=" control-label cf_best_time_of_day_2_870937-label " for="helpdesk_ticket_cf_best_time_of_day_2_870937">Best Time of Day </label> <div class="controls "> <select class=" dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_best_time_of_day_2_870937]" id="helpdesk_ticket_custom_field_cf_best_time_of_day_2_870937"><option value="">...</option> <option data-id="42000258495" value="Mornings">Mornings</option> <option data-id="42000258496" value="Afternoon">Afternoon</option> <option data-id="42000258497" value="Evenings">Evenings</option></select> </div>
<label class=" required control-label cf_csc_branch_870937-label " for="helpdesk_ticket_cf_csc_branch_870937">Related Branch</label> <div class="controls "> <select class=" required dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_csc_branch_870937]" id="helpdesk_ticket_custom_field_cf_csc_branch_870937"><option value="">...</option> <option data-id="42000293838" value="Digital Solutions">Digital Solutions</option> <option data-id="42000293839" value="Card Solutions">Card Solutions</option> <option data-id="42000293840" value="Tax and Legal">Tax and Legal</option> <option data-id="42000293841" value="Overdraft Support">Overdraft Support</option> <option data-id="42000293031" value="ALTAMONT">ALTAMONT</option> <option data-id="42000298408" value="ALTON">ALTON</option> <option data-id="42000298409" value="ARCOLA">ARCOLA</option> <option data-id="42000298410" value="BARTONVILLE">BARTONVILLE</option> <option data-id="42000298411" value="BLOOMINGTON">BLOOMINGTON</option> <option data-id="42000298412" value="BOURBONNAIS">BOURBONNAIS</option> <option data-id="42000298413" value="C CROSSING">C CROSSING</option> <option data-id="42000298414" value="C MARKETVIEW">C MARKETVIEW</option> <option data-id="42000298415" value="C W. CHURCH">C W. CHURCH</option> <option data-id="42000298416" value="CARBONDALE MAIN">CARBONDALE MAIN</option> <option data-id="42000298417" value="CARBONDALE SCHNUCKS">CARBONDALE SCHNUCKS</option> <option data-id="42000298418" value="CARMI">CARMI</option> <option data-id="42000298419" value="CARMI DRIVES">CARMI DRIVES</option> <option data-id="42000298420" value="CARTERVILLE">CARTERVILLE</option> <option data-id="42000298421" value="CHAMPAIGN CHURCH (DOWNTOWN)">CHAMPAIGN CHURCH (DOWNTOWN)</option> <option data-id="42000298422" value="CHAMPAIGN CROSSING">CHAMPAIGN CROSSING</option> <option data-id="42000298423" value="CHAMPAIGN MARKETVIEW">CHAMPAIGN MARKETVIEW</option> <option data-id="42000298424" value="CHARLESTON 6TH ST">CHARLESTON 6TH ST</option> <option data-id="42000298425" value="CHARLESTON LINCOLN">CHARLESTON LINCOLN</option> <option data-id="42000298426" value="CLAYTON">CLAYTON</option> <option data-id="42000298427" value="COLUMBIA MO -5TH">COLUMBIA MO -5TH</option> <option data-id="42000298428" value="COLUMBIA MO -FORUM">COLUMBIA MO -FORUM</option> <option data-id="42000298429" value="COLUMBIA MO- MTG CTR">COLUMBIA MO- MTG CTR</option> <option data-id="42000326005" value="CREVE COEUR MO">CREVE COEUR MO</option> <option data-id="42000298430" value="DE SOTO">DE SOTO</option> <option data-id="42000298431" value="DECATUR AIRPORT (RT 36)">DECATUR AIRPORT (RT 36)</option> <option data-id="42000298432" value="DECATUR ELDORADO">DECATUR ELDORADO</option> <option data-id="42000298433" value="DECATUR FORSYTH">DECATUR FORSYTH</option> <option data-id="42000298434" value="DECATUR MAIN (S WATER ST)">DECATUR MAIN (S WATER ST)</option> <option data-id="42000298435" value="DECATUR NORTH MAIN">DECATUR NORTH MAIN</option> <option data-id="42000298436" value="DECATUR PERSHING">DECATUR PERSHING</option> <option data-id="42000298437" value="DECATUR S FRANKLIN (S SHORES)">DECATUR S FRANKLIN (S SHORES)</option> <option data-id="42000298438" value="EDWARDSVILLE 157">EDWARDSVILLE 157</option> <option data-id="42000298439" value="EDWARDSVILLE GOSHEN">EDWARDSVILLE GOSHEN</option> <option data-id="42000298440" value="EDWARDSVILLE ST. LOUIS ST.">EDWARDSVILLE ST. LOUIS ST.</option> <option data-id="42000298441" value="EFFINGHAM">EFFINGHAM</option> <option data-id="42000298442" value="ELSBERRY MO">ELSBERRY MO</option> <option data-id="42000326006" value="EUREKA MO">EUREKA MO</option> <option data-id="42000298443" value="FAIRVIEW HEIGHTS">FAIRVIEW HEIGHTS</option> <option data-id="42000355084" value="FMIG-INSURANCE">FMIG-INSURANCE</option> <option data-id="42000298444" value="FORSYTH">FORSYTH</option> <option data-id="42000298445" value="GALESBURG HENDERSON">GALESBURG HENDERSON</option> <option data-id="42000298446" value="GALESBURG MAIN">GALESBURG MAIN</option> <option data-id="42000298447" value="GRAPEVINE TX- MTG CTR">GRAPEVINE TX- MTG CTR</option> <option data-id="42000298448" value="GRAPEVINE TX-PREMIER">GRAPEVINE TX-PREMIER</option> <option data-id="42000298449" value="HARRISBURG MAIN (E LOCUST)">HARRISBURG MAIN (E LOCUST)</option> <option data-id="42000298450" value="HARRISBURG SOUTH (ROLLIE MOORE)">HARRISBURG SOUTH (ROLLIE MOORE)</option> <option data-id="42000298451" value="HIGHLAND BROADWAY">HIGHLAND BROADWAY</option> <option data-id="42000298452" value="HIGHLAND MAIN (ST RT 143)">HIGHLAND MAIN (ST RT 143)</option> <option data-id="42000298453" value="INDIANAPOLIS IN">INDIANAPOLIS IN</option> <option data-id="42000298454" value="JEFFERSON MO- MISSOURI">JEFFERSON MO- MISSOURI</option> <option data-id="42000298455" value="JEFFERSON MO-ELLIS">JEFFERSON MO-ELLIS</option> <option data-id="42000298456" value="JEFFERSON MO-STADIUM">JEFFERSON MO-STADIUM</option> <option data-id="42000298457" value="KNOXVILLE">KNOXVILLE</option> <option data-id="42000298458" value="LAKE ST LOUIS MO">LAKE ST LOUIS MO</option> <option data-id="42000298459" value="LAWRENCEVILLE">LAWRENCEVILLE</option> <option data-id="42000298460" value="MAHOMET">MAHOMET</option> <option data-id="42000298461" value="MANSFIELD">MANSFIELD</option> <option data-id="42000298462" value="MARION">MARION</option> <option data-id="42000298463" value="MARSHALL">MARSHALL</option> <option data-id="42000298464" value="MARTINSVILLE">MARTINSVILLE</option> <option data-id="42000298465" value="MATTOON CROSS COUNTY">MATTOON CROSS COUNTY</option> <option data-id="42000298466" value="MATTOON DRIVES">MATTOON DRIVES</option> <option data-id="42000298467" value="MATTOON MAIN (CHARLESTON AVE)">MATTOON MAIN (CHARLESTON AVE)</option> <option data-id="42000298468" value="MONTICELLO">MONTICELLO</option> <option data-id="42000298469" value="MT CARMEL">MT CARMEL</option> <option data-id="42000298470" value="MT VERNON">MT VERNON</option> <option data-id="42000298471" value="MURPHYSBORO">MURPHYSBORO</option> <option data-id="42000298472" value="NEOGA">NEOGA</option> <option data-id="42000326007" value="O'FALLON MO">O'FALLON MO</option> <option data-id="42000298473" value="OSAGE BEACH MO">OSAGE BEACH MO</option> <option data-id="42000298474" value="PARIS">PARIS</option> <option data-id="42000298475" value="PEORIA ADAMS">PEORIA ADAMS</option> <option data-id="42000298476" value="PEORIA KNOXVILLE">PEORIA KNOXVILLE</option> <option data-id="42000298477" value="PEORIA STERLING">PEORIA STERLING</option> <option data-id="42000298478" value="PEORIA UNIVERSITY">PEORIA UNIVERSITY</option> <option data-id="42000298479" value="QUINCY MAIN">QUINCY MAIN</option> <option data-id="42000298480" value="QUINCY MALL">QUINCY MALL</option> <option data-id="42000298481" value="RANTOUL">RANTOUL</option> <option data-id="42000298482" value="SAVOY">SAVOY</option> <option data-id="42000298483" value="ST CHARLES MO">ST CHARLES MO</option> <option data-id="42000298484" value="ST LOUIS MO">ST LOUIS MO</option> <option data-id="42000326008" value="ST LOUIS MO-MARKET ST">ST LOUIS MO-MARKET ST</option> <option data-id="42000326009" value="ST LOUIS MO-SOUTHFIELD CTR">ST LOUIS MO-SOUTHFIELD CTR</option> <option data-id="42000298485" value="ST PETERS MO">ST PETERS MO</option> <option data-id="42000298486" value="SULLIVAN">SULLIVAN</option> <option data-id="42000298487" value="SWANSEA">SWANSEA</option> <option data-id="42000298488" value="TAYLORVILLE">TAYLORVILLE</option> <option data-id="42000298489" value="TUSCOLA">TUSCOLA</option> <option data-id="42000298490" value="URBANA">URBANA</option> <option data-id="42000298491" value="WELDON">WELDON</option> <option data-id="42000298492" value="WINFIELD MO">WINFIELD MO</option> <option data-id="42000298493" value="WOOD RIVER">WOOD RIVER</option> <option data-id="42000347716" value="BELOIT BROAD">BELOIT BROAD</option> <option data-id="42000347717" value="JANESVILLE WI">JANESVILLE WI</option> <option data-id="42000347718" value="BELOIT CRANSTON">BELOIT CRANSTON</option> <option data-id="42000347719" value="MACHESNEY PARK">MACHESNEY PARK</option> <option data-id="42000347720" value="ROSCOE">ROSCOE</option> <option data-id="42000347721" value="ROCKFORD 11TH STREET">ROCKFORD 11TH STREET</option> <option data-id="42000347722" value="ROCKFORD PERRYVILLE">ROCKFORD PERRYVILLE</option> <option data-id="42000347723" value="ST CHARLES IL">ST CHARLES IL</option> <option data-id="42000347724" value="BELVIDERE">BELVIDERE</option> <option data-id="42000347725" value="MCHENRY">MCHENRY</option> <option data-id="42000355211" value="TRUST">TRUST</option> <option data-id="42000355212" value="ITEMS PROCESSING">ITEMS PROCESSING</option></select> </div>
<label class=" required control-label cf_related_branch_manager_870937-label " for="helpdesk_ticket_cf_related_branch_manager_870937">Related Branch Manager</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_related_branch_manager_870937]" id="helpdesk_ticket_custom_field_cf_related_branch_manager_870937" /> </div>
<label class=" required control-label cf_csc_employee_name_870937-label " for="helpdesk_ticket_cf_csc_employee_name_870937">CSC Employee Name</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_csc_employee_name_870937]" id="helpdesk_ticket_custom_field_cf_csc_employee_name_870937" /> </div>
<label class=" required control-label cf_csc_employee_phone_870937-label " for="helpdesk_ticket_cf_csc_employee_phone_870937">CSC Employee Phone</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_csc_employee_phone_870937]" id="helpdesk_ticket_custom_field_cf_csc_employee_phone_870937" /> </div>
<label class=" required control-label cf_csc_employee_email_870937-label " for="helpdesk_ticket_cf_csc_employee_email_870937">CSC Employee Email</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_csc_employee_email_870937]" id="helpdesk_ticket_custom_field_cf_csc_employee_email_870937" /> </div>
<label class=" required control-label cf_account_number_870937-label " for="helpdesk_ticket_cf_account_number_870937">Port No</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_account_number_870937]" id="helpdesk_ticket_custom_field_cf_account_number_870937" /> </div>
<label class=" required control-label cf_customer_name_870937-label " for="helpdesk_ticket_cf_customer_name_870937">Customer Name</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_customer_name_870937]" id="helpdesk_ticket_custom_field_cf_customer_name_870937" /> </div>
<label class=" required control-label cf_cust_phone_870937-label " for="helpdesk_ticket_cf_cust_phone_870937">Customer Phone</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_cust_phone_870937]" id="helpdesk_ticket_custom_field_cf_cust_phone_870937" /> </div>
<label class=" control-label cf_customer_email_870937-label " for="helpdesk_ticket_cf_customer_email_870937">Customer Email</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_customer_email_870937]" id="helpdesk_ticket_custom_field_cf_customer_email_870937" /> </div>
<label class=" control-label cf_type_of_contact_870937-label " for="helpdesk_ticket_cf_type_of_contact_870937">Preferred Method of Contact</label> <div class="controls "> <select class=" dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_type_of_contact_870937]" id="helpdesk_ticket_custom_field_cf_type_of_contact_870937"><option value="">...</option> <option data-id="42000153063" value="Telephone">Telephone</option> <option data-id="42000153065" value="Email">Email</option> <option data-id="42000153064" value="In Writing">In Writing</option></select> </div>
<label class=" control-label cf_best_time_of_day_870937-label " for="helpdesk_ticket_cf_best_time_of_day_870937">Best Time of Day</label> <div class="controls "> <select class=" dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_best_time_of_day_870937]" id="helpdesk_ticket_custom_field_cf_best_time_of_day_870937"><option value="">...</option> <option data-id="42000258491" value="Mornings">Mornings</option> <option data-id="42000258492" value="Afternoons">Afternoons</option> <option data-id="42000258493" value="Evenings">Evenings</option></select> </div>
<div class="controls"> <label class="checkbox "> <input name="helpdesk_ticket[custom_field][cf_is_the_issue_resolved_870937]" type="hidden" value="0" /><input class=" checkbox section_field" id="helpdesk_ticket_custom_field_cf_is_the_issue_resolved_870937_42000267487" type="checkbox" value="1" name="helpdesk_ticket[custom_field][cf_is_the_issue_resolved_870937]" /> Check mark here if the issue is resolved. </label> </div>
<label class=" required control-label cf_branch_870937-label " for="helpdesk_ticket_cf_branch_870937">Branch</label> <div class="controls "> <select class=" required dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_branch_870937]" id="helpdesk_ticket_custom_field_cf_branch_870937"><option value="">...</option> <option data-id="42000268067" value="Ag Services">Ag Services</option> <option data-id="42000292122" value="Branch Support">Branch Support</option> <option data-id="42000265376" value="Card Solutions">Card Solutions</option> <option data-id="42000333577" value="Compliance Department">Compliance Department</option> <option data-id="42000272556" value="Digital Solutions">Digital Solutions</option> <option data-id="42000268069" value="FMIG- INSURANCE">FMIG- INSURANCE</option> <option data-id="42000264619" value="Loan Operations">Loan Operations</option> <option data-id="42000328229" value="Overdraft Support">Overdraft Support</option> <option data-id="42000272798" value="Raymond James">Raymond James</option> <option data-id="42000328230" value="Tax and Legal">Tax and Legal</option> <option data-id="42000333578" value="Treasury Management">Treasury Management</option> <option data-id="42000268068" value="Wealth Management">Wealth Management</option> <option data-id="42000298494" value="ALTAMONT">ALTAMONT</option> <option data-id="42000298495" value="ALTON">ALTON</option> <option data-id="42000298496" value="ARCOLA">ARCOLA</option> <option data-id="42000298497" value="BARTONVILLE">BARTONVILLE</option> <option data-id="42000298498" value="BLOOMINGTON">BLOOMINGTON</option> <option data-id="42000298499" value="BOURBONNAIS">BOURBONNAIS</option> <option data-id="42000298500" value="C CROSSING">C CROSSING</option> <option data-id="42000298501" value="C MARKETVIEW">C MARKETVIEW</option> <option data-id="42000254804" value="CSC">CSC</option> <option data-id="42000298502" value="C W. CHURCH">C W. CHURCH</option> <option data-id="42000298503" value="CARBONDALE MAIN">CARBONDALE MAIN</option> <option data-id="42000298504" value="CARBONDALE SCHNUCKS">CARBONDALE SCHNUCKS</option> <option data-id="42000298505" value="CARMI">CARMI</option> <option data-id="42000298506" value="CARMI DRIVES">CARMI DRIVES</option> <option data-id="42000298507" value="CARTERVILLE">CARTERVILLE</option> <option data-id="42000298508" value="CHAMPAIGN CHURCH (DOWNTOWN)">CHAMPAIGN CHURCH (DOWNTOWN)</option> <option data-id="42000298509" value="CHAMPAIGN CROSSING">CHAMPAIGN CROSSING</option> <option data-id="42000298510" value="CHAMPAIGN MARKETVIEW">CHAMPAIGN MARKETVIEW</option> <option data-id="42000298511" value="CHARLESTON 6TH ST">CHARLESTON 6TH ST</option> <option data-id="42000298512" value="CHARLESTON LINCOLN">CHARLESTON LINCOLN</option> <option data-id="42000298513" value="CLAYTON">CLAYTON</option> <option data-id="42000298514" value="COLUMBIA MO -5TH">COLUMBIA MO -5TH</option> <option data-id="42000298515" value="COLUMBIA MO -FORUM">COLUMBIA MO -FORUM</option> <option data-id="42000298516" value="COLUMBIA MO- MTG CTR">COLUMBIA MO- MTG CTR</option> <option data-id="42000326000" value="CREVE COEUR MO">CREVE COEUR MO</option> <option data-id="42000298517" value="DE SOTO">DE SOTO</option> <option data-id="42000298518" value="DECATUR AIRPORT (RT 36)">DECATUR AIRPORT (RT 36)</option> <option data-id="42000298519" value="DECATUR ELDORADO">DECATUR ELDORADO</option> <option data-id="42000298520" value="DECATUR FORSYTH">DECATUR FORSYTH</option> <option data-id="42000298521" value="DECATUR MAIN (S WATER ST)">DECATUR MAIN (S WATER ST)</option> <option data-id="42000298522" value="DECATUR NORTH MAIN">DECATUR NORTH MAIN</option> <option data-id="42000298523" value="DECATUR PERSHING">DECATUR PERSHING</option> <option data-id="42000298524" value="DECATUR S FRANKLIN (S SHORES)">DECATUR S FRANKLIN (S SHORES)</option> <option data-id="42000298525" value="EDWARDSVILLE 157">EDWARDSVILLE 157</option> <option data-id="42000298526" value="EDWARDSVILLE GOSHEN">EDWARDSVILLE GOSHEN</option> <option data-id="42000298527" value="EDWARDSVILLE ST. LOUIS ST.">EDWARDSVILLE ST. LOUIS ST.</option> <option data-id="42000298528" value="EFFINGHAM">EFFINGHAM</option> <option data-id="42000298529" value="ELSBERRY MO">ELSBERRY MO</option> <option data-id="42000326001" value="EUREKA MO">EUREKA MO</option> <option data-id="42000298530" value="FAIRVIEW HEIGHTS">FAIRVIEW HEIGHTS</option> <option data-id="42000298531" value="FORSYTH">FORSYTH</option> <option data-id="42000298532" value="GALESBURG HENDERSON">GALESBURG HENDERSON</option> <option data-id="42000298533" value="GALESBURG MAIN">GALESBURG MAIN</option> <option data-id="42000298534" value="GRAPEVINE TX- MTG CTR">GRAPEVINE TX- MTG CTR</option> <option data-id="42000298535" value="GRAPEVINE TX-PREMIER">GRAPEVINE TX-PREMIER</option> <option data-id="42000298536" value="HARRISBURG MAIN (E LOCUST)">HARRISBURG MAIN (E LOCUST)</option> <option data-id="42000298537" value="HARRISBURG SOUTH (ROLLIE MOORE)">HARRISBURG SOUTH (ROLLIE MOORE)</option> <option data-id="42000298538" value="HIGHLAND BROADWAY">HIGHLAND BROADWAY</option> <option data-id="42000298539" value="HIGHLAND MAIN (ST RT 143)">HIGHLAND MAIN (ST RT 143)</option> <option data-id="42000298540" value="INDIANAPOLIS IN">INDIANAPOLIS IN</option> <option data-id="42000298541" value="JEFFERSON MO- MISSOURI">JEFFERSON MO- MISSOURI</option> <option data-id="42000298542" value="JEFFERSON MO-ELLIS">JEFFERSON MO-ELLIS</option> <option data-id="42000298543" value="JEFFERSON MO-STADIUM">JEFFERSON MO-STADIUM</option> <option data-id="42000298544" value="KNOXVILLE">KNOXVILLE</option> <option data-id="42000298545" value="LAKE ST LOUIS MO">LAKE ST LOUIS MO</option> <option data-id="42000298546" value="LAWRENCEVILLE">LAWRENCEVILLE</option> <option data-id="42000298547" value="MAHOMET">MAHOMET</option> <option data-id="42000298548" value="MANSFIELD">MANSFIELD</option> <option data-id="42000298549" value="MARION">MARION</option> <option data-id="42000298550" value="MARSHALL">MARSHALL</option> <option data-id="42000298551" value="MARTINSVILLE">MARTINSVILLE</option> <option data-id="42000298552" value="MATTOON CROSS COUNTY">MATTOON CROSS COUNTY</option> <option data-id="42000298553" value="MATTOON DRIVES">MATTOON DRIVES</option> <option data-id="42000298554" value="MATTOON MAIN (CHARLESTON AVE)">MATTOON MAIN (CHARLESTON AVE)</option> <option data-id="42000298555" value="MONTICELLO">MONTICELLO</option> <option data-id="42000298556" value="MT CARMEL">MT CARMEL</option> <option data-id="42000298557" value="MT VERNON">MT VERNON</option> <option data-id="42000298558" value="MURPHYSBORO">MURPHYSBORO</option> <option data-id="42000298559" value="NEOGA">NEOGA</option> <option data-id="42000326002" value="O'FALLON MO">O'FALLON MO</option> <option data-id="42000298560" value="OSAGE BEACH MO">OSAGE BEACH MO</option> <option data-id="42000298561" value="PARIS">PARIS</option> <option data-id="42000298562" value="PEORIA ADAMS">PEORIA ADAMS</option> <option data-id="42000298563" value="PEORIA KNOXVILLE">PEORIA KNOXVILLE</option> <option data-id="42000298564" value="PEORIA STERLING">PEORIA STERLING</option> <option data-id="42000298565" value="PEORIA UNIVERSITY">PEORIA UNIVERSITY</option> <option data-id="42000298566" value="QUINCY MAIN">QUINCY MAIN</option> <option data-id="42000298567" value="QUINCY MALL">QUINCY MALL</option> <option data-id="42000298568" value="RANTOUL">RANTOUL</option> <option data-id="42000298569" value="SAVOY">SAVOY</option> <option data-id="42000298570" value="ST CHARLES MO">ST CHARLES MO</option> <option data-id="42000298571" value="ST LOUIS MO">ST LOUIS MO</option> <option data-id="42000326003" value="ST LOUIS MO-MARKET ST">ST LOUIS MO-MARKET ST</option> <option data-id="42000326004" value="ST LOUIS MO-SOUTHFIELD CTR">ST LOUIS MO-SOUTHFIELD CTR</option> <option data-id="42000298572" value="ST PETERS MO">ST PETERS MO</option> <option data-id="42000298573" value="SULLIVAN">SULLIVAN</option> <option data-id="42000298574" value="SWANSEA">SWANSEA</option> <option data-id="42000298575" value="TAYLORVILLE">TAYLORVILLE</option> <option data-id="42000298576" value="TUSCOLA">TUSCOLA</option> <option data-id="42000298577" value="URBANA">URBANA</option> <option data-id="42000298578" value="WELDON">WELDON</option> <option data-id="42000298579" value="WINFIELD MO">WINFIELD MO</option> <option data-id="42000298580" value="WOOD RIVER">WOOD RIVER</option> <option data-id="42000347706" value="BELOIT BROAD">BELOIT BROAD</option> <option data-id="42000347707" value="JANESVILLE WI">JANESVILLE WI</option> <option data-id="42000347708" value="BELOIT CRANSTON">BELOIT CRANSTON</option> <option data-id="42000347709" value="MACHESNEY PARK">MACHESNEY PARK</option> <option data-id="42000347710" value="ROSCOE">ROSCOE</option> <option data-id="42000347711" value="ROCKFORD 11TH STREET">ROCKFORD 11TH STREET</option> <option data-id="42000347712" value="ROCKFORD PERRYVILLE">ROCKFORD PERRYVILLE</option> <option data-id="42000347713" value="ST CHARLES IL">ST CHARLES IL</option> <option data-id="42000347714" value="BELVIDERE">BELVIDERE</option> <option data-id="42000347715" value="MCHENRY">MCHENRY</option> <option data-id="42000355213" value="TRUST">TRUST</option> <option data-id="42000355214" value="ITEMS PROCESSING">ITEMS PROCESSING</option></select> </div>
<label class=" required control-label cf_managers_email_870937-label " for="helpdesk_ticket_cf_managers_email_870937">Manager's Email (INPUT ONE VALID EMAIL ADDRESS)</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_managers_email_870937]" id="helpdesk_ticket_custom_field_cf_managers_email_870937" /> </div>
<label class=" required control-label cf_branch_employee_name_870937-label " for="helpdesk_ticket_cf_branch_employee_name_870937">Branch Employee Name</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_branch_employee_name_870937]" id="helpdesk_ticket_custom_field_cf_branch_employee_name_870937" /> </div>
<label class=" required control-label cf_branch_phone_870937-label " for="helpdesk_ticket_cf_branch_phone_870937">Branch Employee Phone</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_branch_phone_870937]" id="helpdesk_ticket_custom_field_cf_branch_phone_870937" /> </div>
<label class=" required control-label cf_operations_services_870937-label " for="helpdesk_ticket_cf_operations_services_870937">Operations Services</label> <div class="controls nested_field "> <select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_operations_services_870937_42000322272" name="helpdesk_ticket[custom_field][cf_operations_services_870937]"><option value="">...</option> <option value="Change File Maintenance">Change File Maintenance</option> <option value="Check File Maintenance">Check File Maintenance</option> <option value="Dormant Accounts">Dormant Accounts</option> <option value="Exception Item Processing (EIM)">Exception Item Processing (EIM)</option> <option value="General Inquiry">General Inquiry</option> <option value="Holds">Holds</option> <option value="Quality Assurance">Quality Assurance</option> <option value="Research">Research</option> <option value="Returned Items">Returned Items</option> <option value="Stop Payment">Stop Payment</option></select><div class="level_2"><label class="required">Additional Information</label><select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_required_information_870937_42000322272" name="helpdesk_ticket[custom_field][cf_required_information_870937]"><option value="">...</option> </select></div><script> //<![CDATA[ jQuery('#helpdesk_ticket_custom_field_cf_operations_services_870937_42000322272').nested_select_tag({"data_tree":[["Change File Maintenance","Change File Maintenance",[]],["Check File Maintenance","Check File Maintenance",[["Other","Other",[]],["SDB Maintenance","SDB Maintenance",[]],["Supporting Legal Documents","Supporting Legal Documents",[]]]],["Dormant Accounts","Dormant Accounts",[]],["Exception Item Processing (EIM)","Exception Item Processing (EIM)",[["Non-Post","Non-Post",[]],["NSF","NSF",[]]]],["General Inquiry","General Inquiry",[]],["Holds","Holds",[["New Hold","New Hold",[]],["Delete Hold","Delete Hold",[]]]],["Quality Assurance","Quality Assurance",[]],["Research","Research",[["ATTACH REQUEST FORM","ATTACH REQUEST FORM",[]]]],["Returned Items","Returned Items",[]],["Stop Payment","Stop Payment",[["New Stop Payment","New Stop Payment",[]],["Release Stop Payment","Release Stop Payment",[]]]]],"initValues":null,"disable_children":false,"include_blank":"...","selected":null,"pl_value_id":"42000322272","subcategory_id":"helpdesk_ticket_custom_field_cf_required_information_870937_42000322272"}); //]]> </script> </div>
<label class=" control-label cf_ops_customer_name_870937-label " for="helpdesk_ticket_cf_ops_customer_name_870937">Customer Name</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_ops_customer_name_870937]" id="helpdesk_ticket_custom_field_cf_ops_customer_name_870937" /> </div>
<label class=" control-label cf_ops_acct_number_870937-label " for="helpdesk_ticket_cf_ops_acct_number_870937">Account Number</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_ops_acct_number_870937]" id="helpdesk_ticket_custom_field_cf_ops_acct_number_870937" /> </div>
<label class=" required control-label cf_employee_department_870937-label " for="helpdesk_ticket_cf_employee_department_870937">Employee Department</label> <div class="controls "> <select class=" required dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_employee_department_870937]" id="helpdesk_ticket_custom_field_cf_employee_department_870937"><option value="">...</option> <option data-id="42000341050" value="Ag Services">Ag Services</option> <option data-id="42000347253" value="Call Center">Call Center</option> <option data-id="42000347254" value="Cards">Cards</option> <option data-id="42000341051" value="Deposit Services">Deposit Services</option> <option data-id="42000347255" value="Digital">Digital</option> <option data-id="42000347256" value="Edwardsville Operations">Edwardsville Operations</option> <option data-id="42000341052" value="Human Resources">Human Resources</option> <option data-id="42000341053" value="Insurance">Insurance</option> <option data-id="42000341054" value="Investment Services">Investment Services</option> <option data-id="42000347257" value="Liability Support">Liability Support</option> <option data-id="42000341055" value="Loans">Loans</option> <option data-id="42000341056" value="MIDS">MIDS</option> <option data-id="42000341057" value="Treasury Management">Treasury Management</option> <option data-id="42000341058" value="Trust">Trust</option> <option data-id="42000347258" value="Overdrafts">Overdrafts</option></select> </div>
<label class=" required control-label cf_branch_listing_bsa_870937-label " for="helpdesk_ticket_cf_branch_listing_bsa_870937">Location</label> <div class="controls "> <select class=" required dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_branch_listing_bsa_870937]" id="helpdesk_ticket_custom_field_cf_branch_listing_bsa_870937"><option value="">...</option> <option data-id="42000298330" value="ALTAMONT">ALTAMONT</option> <option data-id="42000298321" value="ALTON">ALTON</option> <option data-id="42000298322" value="ARCOLA">ARCOLA</option> <option data-id="42000298323" value="BARTONVILLE">BARTONVILLE</option> <option data-id="42000347736" value="BELOIT BROAD">BELOIT BROAD</option> <option data-id="42000347737" value="BELOIT CRANSTON">BELOIT CRANSTON</option> <option data-id="42000347738" value="BELVIDERE">BELVIDERE</option> <option data-id="42000298324" value="BLOOMINGTON">BLOOMINGTON</option> <option data-id="42000298325" value="BOURBONNAIS">BOURBONNAIS</option> <option data-id="42000298331" value="CARBONDALE MAIN">CARBONDALE MAIN</option> <option data-id="42000298332" value="CARBONDALE SCHNUCKS">CARBONDALE SCHNUCKS</option> <option data-id="42000298333" value="CARMI">CARMI</option> <option data-id="42000298329" value="CARMI DRIVES">CARMI DRIVES</option> <option data-id="42000298334" value="CARTERVILLE">CARTERVILLE</option> <option data-id="42000298335" value="CHAMPAIGN CHURCH (DOWNTOWN)">CHAMPAIGN CHURCH (DOWNTOWN)</option> <option data-id="42000298336" value="CHAMPAIGN CROSSING">CHAMPAIGN CROSSING</option> <option data-id="42000298337" value="CHAMPAIGN MARKETVIEW">CHAMPAIGN MARKETVIEW</option> <option data-id="42000298339" value="CHARLESTON LINCOLN">CHARLESTON LINCOLN</option> <option data-id="42000298340" value="CLAYTON">CLAYTON</option> <option data-id="42000298341" value="COLUMBIA MO -5TH">COLUMBIA MO -5TH</option> <option data-id="42000298342" value="COLUMBIA MO -FORUM">COLUMBIA MO -FORUM</option> <option data-id="42000298343" value="COLUMBIA MO- MTG CTR">COLUMBIA MO- MTG CTR</option> <option data-id="42000326012" value="CREVE COEUR MO">CREVE COEUR MO</option> <option data-id="42000298344" value="DE SOTO">DE SOTO</option> <option data-id="42000298345" value="DECATUR AIRPORT (RT 36)">DECATUR AIRPORT (RT 36)</option> <option data-id="42000298346" value="DECATUR ELDORADO">DECATUR ELDORADO</option> <option data-id="42000298347" value="DECATUR FORSYTH">DECATUR FORSYTH</option> <option data-id="42000298348" value="DECATUR MAIN (S WATER ST)">DECATUR MAIN (S WATER ST)</option> <option data-id="42000298349" value="DECATUR NORTH MAIN">DECATUR NORTH MAIN</option> <option data-id="42000298350" value="DECATUR PERSHING">DECATUR PERSHING</option> <option data-id="42000298351" value="DECATUR S FRANKLIN (S SHORES)">DECATUR S FRANKLIN (S SHORES)</option> <option data-id="42000298352" value="EDWARDSVILLE 157">EDWARDSVILLE 157</option> <option data-id="42000298353" value="EDWARDSVILLE GOSHEN">EDWARDSVILLE GOSHEN</option> <option data-id="42000298354" value="EDWARDSVILLE ST. LOUIS ST.">EDWARDSVILLE ST. LOUIS ST.</option> <option data-id="42000298355" value="EFFINGHAM">EFFINGHAM</option> <option data-id="42000298356" value="ELSBERRY MO">ELSBERRY MO</option> <option data-id="42000326011" value="EUREKA MO">EUREKA MO</option> <option data-id="42000298357" value="FAIRVIEW HEIGHTS">FAIRVIEW HEIGHTS</option> <option data-id="42000298358" value="FORSYTH">FORSYTH</option> <option data-id="42000298359" value="GALESBURG HENDERSON">GALESBURG HENDERSON</option> <option data-id="42000298360" value="GALESBURG MAIN">GALESBURG MAIN</option> <option data-id="42000298361" value="GRAPEVINE TX- MTG CTR">GRAPEVINE TX- MTG CTR</option> <option data-id="42000298362" value="GRAPEVINE TX-PREMIER">GRAPEVINE TX-PREMIER</option> <option data-id="42000298363" value="HARRISBURG MAIN (E LOCUST)">HARRISBURG MAIN (E LOCUST)</option> <option data-id="42000298364" value="HARRISBURG SOUTH (ROLLIE MOORE)">HARRISBURG SOUTH (ROLLIE MOORE)</option> <option data-id="42000298365" value="HIGHLAND BROADWAY">HIGHLAND BROADWAY</option> <option data-id="42000298366" value="HIGHLAND MAIN (ST RT 143)">HIGHLAND MAIN (ST RT 143)</option> <option data-id="42000298367" value="INDIANAPOLIS IN">INDIANAPOLIS IN</option> <option data-id="42000347739" value="JANESVILLE WI">JANESVILLE WI</option> <option data-id="42000298368" value="JEFFERSON MO- MISSOURI">JEFFERSON MO- MISSOURI</option> <option data-id="42000298369" value="JEFFERSON MO-ELLIS">JEFFERSON MO-ELLIS</option> <option data-id="42000298370" value="JEFFERSON MO-STADIUM">JEFFERSON MO-STADIUM</option> <option data-id="42000298371" value="KNOXVILLE">KNOXVILLE</option> <option data-id="42000298372" value="LAKE ST LOUIS MO">LAKE ST LOUIS MO</option> <option data-id="42000298373" value="LAWRENCEVILLE">LAWRENCEVILLE</option> <option data-id="42000347740" value="MACHESNEY PARK">MACHESNEY PARK</option> <option data-id="42000298374" value="MAHOMET">MAHOMET</option> <option data-id="42000298375" value="MANSFIELD">MANSFIELD</option> <option data-id="42000298376" value="MARION">MARION</option> <option data-id="42000298377" value="MARSHALL">MARSHALL</option> <option data-id="42000298378" value="MARTINSVILLE">MARTINSVILLE</option> <option data-id="42000347409" value="MATTOON CORPORATE">MATTOON CORPORATE</option> <option data-id="42000298379" value="MATTOON CROSS COUNTY">MATTOON CROSS COUNTY</option> <option data-id="42000298380" value="MATTOON DRIVES">MATTOON DRIVES</option> <option data-id="42000298381" value="MATTOON MAIN (CHARLESTON AVE)">MATTOON MAIN (CHARLESTON AVE)</option> <option data-id="42000347741" value="MCHENRY">MCHENRY</option> <option data-id="42000298382" value="MONTICELLO">MONTICELLO</option> <option data-id="42000298383" value="MT CARMEL">MT CARMEL</option> <option data-id="42000298384" value="MT VERNON">MT VERNON</option> <option data-id="42000298385" value="MURPHYSBORO">MURPHYSBORO</option> <option data-id="42000298386" value="NEOGA">NEOGA</option> <option data-id="42000326010" value="O'FALLON MO">O'FALLON MO</option> <option data-id="42000298387" value="OSAGE BEACH MO">OSAGE BEACH MO</option> <option data-id="42000298388" value="PARIS">PARIS</option> <option data-id="42000298389" value="PEORIA ADAMS">PEORIA ADAMS</option> <option data-id="42000298390" value="PEORIA KNOXVILLE">PEORIA KNOXVILLE</option> <option data-id="42000298391" value="PEORIA STERLING">PEORIA STERLING</option> <option data-id="42000298392" value="PEORIA UNIVERSITY">PEORIA UNIVERSITY</option> <option data-id="42000298393" value="QUINCY MAIN">QUINCY MAIN</option> <option data-id="42000298394" value="QUINCY MALL">QUINCY MALL</option> <option data-id="42000298395" value="RANTOUL">RANTOUL</option> <option data-id="42000347742" value="ROCKFORD 11TH STREET">ROCKFORD 11TH STREET</option> <option data-id="42000347743" value="ROCKFORD PERRYVILLE">ROCKFORD PERRYVILLE</option> <option data-id="42000347744" value="ROSCOE">ROSCOE</option> <option data-id="42000298396" value="SAVOY">SAVOY</option> <option data-id="42000347745" value="ST CHARLES IL">ST CHARLES IL</option> <option data-id="42000298397" value="ST CHARLES MO">ST CHARLES MO</option> <option data-id="42000298398" value="ST LOUIS MO">ST LOUIS MO</option> <option data-id="42000326014" value="ST LOUIS MO-MARKET ST">ST LOUIS MO-MARKET ST</option> <option data-id="42000326013" value="ST LOUIS MO-SOUTHFIELD CTR">ST LOUIS MO-SOUTHFIELD CTR</option> <option data-id="42000298399" value="ST PETERS MO">ST PETERS MO</option> <option data-id="42000298400" value="SULLIVAN">SULLIVAN</option> <option data-id="42000298401" value="SWANSEA">SWANSEA</option> <option data-id="42000298402" value="TAYLORVILLE">TAYLORVILLE</option> <option data-id="42000298403" value="TUSCOLA">TUSCOLA</option> <option data-id="42000298404" value="URBANA">URBANA</option> <option data-id="42000298405" value="WELDON">WELDON</option> <option data-id="42000298406" value="WINFIELD MO">WINFIELD MO</option> <option data-id="42000298407" value="WOOD RIVER">WOOD RIVER</option></select> </div>
<label class=" required control-label cf_productrequest_870937-label " for="helpdesk_ticket_cf_productrequest_870937">Product/Request</label> <div class="controls nested_field "> <select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_productrequest_870937_42000289085" name="helpdesk_ticket[custom_field][cf_productrequest_870937]"><option value="">...</option> <option value="GENERAL INQUIRY">GENERAL INQUIRY</option> <option value="COMMERCIAL OLB">COMMERCIAL OLB</option> <option value="BUSINESS OLB">BUSINESS OLB</option> <option value="RETAIL OLB">RETAIL OLB</option> <option value="WEILAND">WEILAND</option> <option value="WIRES">WIRES</option> <option value="DEATH NOTIFICATION">DEATH NOTIFICATION</option> <option value="ACH RESEARCH">ACH RESEARCH</option> <option value="ANOMALY DETECTION">ANOMALY DETECTION</option> <option value="CASHLETTER | EIM">CASHLETTER | EIM</option> <option value="QUALITY ASSURANCE">QUALITY ASSURANCE</option> <option value="MOBILE DEPOSIT INQUIRY">MOBILE DEPOSIT INQUIRY</option> <option value="EMAIL INQUIRY">EMAIL INQUIRY</option></select><div class="level_2"><label class="required">Services</label><select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_new_or_existing_870937_42000289085" name="helpdesk_ticket[custom_field][cf_new_or_existing_870937]"><option value="">...</option> </select></div><div class="level_3"><label class="required">New or Existing</label><select class=" required nested_field section_field" id="helpdesk_ticket_custom_field_cf_services_870937_42000289085" name="helpdesk_ticket[custom_field][cf_services_870937]"><option value="">...</option> </select></div><script> //<![CDATA[ jQuery('#helpdesk_ticket_custom_field_cf_productrequest_870937_42000289085').nested_select_tag({"data_tree":[["GENERAL INQUIRY","GENERAL INQUIRY",[]],["COMMERCIAL OLB","COMMERCIAL OLB",[["ACH","ACH",[["ADD NEW","ADD NEW"],["ADD EXISTING","ADD EXISTING"],["CHANGE EXISTING","CHANGE EXISTING"],["OTHER","OTHER"]]],["ADD ACCOUNT","ADD ACCOUNT",[]],["BILL PAY","BILL PAY",[["ADD NEW","ADD NEW"],["ADD EXISTING","ADD EXISTING"],["CHANGE EXISTING","CHANGE EXISTING"],["OTHER","OTHER"]]],["ESTATEMENTS","ESTATEMENTS",[["ADD NEW","ADD NEW"],["ADD EXISTING","ADD EXISTING"],["CHANGE EXISTING","CHANGE EXISTING"],["OTHER","OTHER"]]],["FRAUD FILTER","FRAUD FILTER",[["ADD NEW","ADD NEW"],["ADD EXISTING","ADD EXISTING"],["CHANGE EXISTING","CHANGE EXISTING"],["OTHER","OTHER"]]],["LIMIT CHANGES","LIMIT CHANGES",[["ADD NEW","ADD NEW"],["ADD EXISTING","ADD EXISTING"],["CHANGE EXISTING","CHANGE EXISTING"],["OTHER","OTHER"]]],["MAINTENANCE","MAINTENANCE",[["ADD NEW","ADD NEW"],["ADD EXISTING","ADD EXISTING"],["CHANGE EXISTING","CHANGE EXISTING"],["OTHER","OTHER"]]],["MOBILE","MOBILE",[["ADD NEW","ADD NEW"],["ADD EXISTING","ADD EXISTING"],["CHANGE EXISTING","CHANGE EXISTING"],["OTHER","OTHER"]]],["POS PAY","POS PAY",[["ADD NEW","ADD NEW"],["ADD EXISTING","ADD EXISTING"],["CHANGE EXISTING","CHANGE EXISTING"],["OTHER","OTHER"]]],["QUICK BOOKS","QUICK BOOKS",[["ADD NEW","ADD NEW"],["ADD EXISTING","ADD EXISTING"],["CHANGE EXISTING","CHANGE EXISTING"],["OTHER","OTHER"]]],["REMOTE DEPOSIT","REMOTE DEPOSIT",[["ADD NEW","ADD NEW"],["ADD EXISTING","ADD EXISTING"],["CHANGE EXISTING","CHANGE EXISTING"],["OTHER","OTHER"]]],["WIRE","WIRE",[["ADD NEW","ADD NEW"],["ADD EXISTING","ADD EXISTING"],["CHANGE EXISTING","CHANGE EXISTING"],["OTHER","OTHER"]]]]],["BUSINESS OLB","BUSINESS OLB",[["ADD ACCOUNT","ADD ACCOUNT",[]],["BILL PAY","BILL PAY",[["ADD NEW","ADD NEW"],["ADD EXISTING","ADD EXISTING"],["CHANGE EXISTING","CHANGE EXISTING"]]],["ENROLLMENT","ENROLLMENT",[["ADD NEW","ADD NEW"],["ADD EXISTING","ADD EXISTING"],["CHANGE EXISTING","CHANGE EXISTING"]]],["ESTATEMENTS","ESTATEMENTS",[["ADD NEW","ADD NEW"],["ADD EXISTING","ADD EXISTING"],["CHANGE EXISTING","CHANGE EXISTING"]]],["MAINTENANCE","MAINTENANCE",[["ADD NEW","ADD NEW"],["ADD EXISTING","ADD EXISTING"],["CHANGE EXISTING","CHANGE EXISTING"]]],["MOBILE","MOBILE",[["ADD NEW","ADD NEW"],["ADD EXISTING","ADD EXISTING"],["CHANGE EXISTING","CHANGE EXISTING"]]],["MOBILE DEPOSIT","MOBILE DEPOSIT",[["ADD NEW","ADD NEW"],["ADD EXISTING","ADD EXISTING"],["CHANGE EXISTING","CHANGE EXISTING"]]],["QUICK BOOKS","QUICK BOOKS",[["ADD NEW","ADD NEW"],["ADD EXISTING","ADD EXISTING"],["CHANGE EXISTING","CHANGE EXISTING"]]],["DIRECT CONNECT","DIRECT CONNECT",[]]]],["RETAIL OLB","RETAIL OLB",[["BILL PAY","BILL PAY",[["ADD NEW","ADD NEW"],["ADD EXISTING","ADD EXISTING"],["CHANGE EXISTING","CHANGE EXISTING"]]],["ESTATEMENTS","ESTATEMENTS",[["ADD NEW","ADD NEW"],["ADD EXISTING","ADD EXISTING"],["CHANGE EXISTING","CHANGE EXISTING"]]],["INTERNATIONAL CUSTOMER","INTERNATIONAL CUSTOMER",[["ADD NEW","ADD NEW"],["ADD EXISTING","ADD EXISTING"],["CHANGE EXISTING","CHANGE EXISTING"]]],["MOBILE","MOBILE",[["ADD NEW","ADD NEW"],["ADD EXISTING","ADD EXISTING"],["CHANGE EXISTING","CHANGE EXISTING"]]],["TRANSFER NOW","TRANSFER NOW",[["AV CALL","AV CALL"],["ADD NEW","ADD NEW"],["ADD EXISTING","ADD EXISTING"],["CHANGE EXISTING","CHANGE EXISTING"]]]]],["WEILAND","WEILAND",[]],["WIRES","WIRES",[["INCOMING WIRE FEES","INCOMING WIRE FEES",[]],["RESEARCH","RESEARCH",[]],["DRAW DOWN","DRAW DOWN",[]],["FX-FOREIGN CURRENCY","FX-FOREIGN CURRENCY",[]],["TAX PAYMENT","TAX PAYMENT",[]],["SERVICE MESSAGE","SERVICE MESSAGE",[]]]],["DEATH NOTIFICATION","DEATH NOTIFICATION",[["Bank Notification","Bank Notification",[]],["DNE – Fed Notice","DNE – Fed Notice",[]],["Reclamation","Reclamation",[]]]],["ACH RESEARCH","ACH RESEARCH",[["Chargeback – Return Item","Chargeback – Return Item",[]],["Dispute Returns","Dispute Returns",[]],["[NOC] Notification of Change","[NOC] Notification of Change",[]],["Original Source Document Request","Original Source Document Request",[]],["Research","Research",[]]]],["ANOMALY DETECTION","ANOMALY DETECTION",[]],["CASHLETTER | EIM","CASHLETTER | EIM",[]],["QUALITY ASSURANCE","QUALITY ASSURANCE",[]],["MOBILE DEPOSIT INQUIRY","MOBILE DEPOSIT INQUIRY",[]],["EMAIL INQUIRY","EMAIL INQUIRY",[]]],"initValues":null,"disable_children":false,"include_blank":"...","selected":null,"pl_value_id":"42000289085","subcategory_id":"helpdesk_ticket_custom_field_cf_new_or_existing_870937_42000289085","item_id":"helpdesk_ticket_custom_field_cf_services_870937_42000289085"}); //]]> </script> </div>
<label class=" required control-label cf_customer_name774765_870937-label " for="helpdesk_ticket_cf_customer_name774765_870937">Requestor Name</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_customer_name774765_870937]" id="helpdesk_ticket_custom_field_cf_customer_name774765_870937" /> </div>
<label class=" required control-label cf_business_name_870937-label " for="helpdesk_ticket_cf_business_name_870937">Business/Customer Name</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_business_name_870937]" id="helpdesk_ticket_custom_field_cf_business_name_870937" /> </div>
<label class=" control-label cf_tax_id_870937-label " for="helpdesk_ticket_cf_tax_id_870937">Tax ID</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_tax_id_870937]" id="helpdesk_ticket_custom_field_cf_tax_id_870937" /> </div>
<label class=" required control-label cf_account_number529801_870937-label " for="helpdesk_ticket_cf_account_number529801_870937">Account Number</label> <div class="controls "> <input class=" required number section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_account_number529801_870937]" id="helpdesk_ticket_custom_field_cf_account_number529801_870937" /> </div>
<label class=" control-label cf_customer_email629454_870937-label " for="helpdesk_ticket_cf_customer_email629454_870937">Customer Email</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_customer_email629454_870937]" id="helpdesk_ticket_custom_field_cf_customer_email629454_870937" /> </div>
<label class=" control-label cf_call_back_number_870937-label " for="helpdesk_ticket_cf_call_back_number_870937">Call Back Number</label> <div class="controls "> <input class=" number section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_call_back_number_870937]" id="helpdesk_ticket_custom_field_cf_call_back_number_870937" /> </div>
<label class=" required control-label cf_port_number405726_870937-label " for="helpdesk_ticket_cf_port_number405726_870937">Port Number</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_port_number405726_870937]" id="helpdesk_ticket_custom_field_cf_port_number405726_870937" /> </div>
<label class=" required control-label cf_customerbusiness_name_870937-label " for="helpdesk_ticket_cf_customerbusiness_name_870937">Customer Name</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_customerbusiness_name_870937]" id="helpdesk_ticket_custom_field_cf_customerbusiness_name_870937" /> </div>
<label class=" required control-label cf_customerbusiness_phone_870937-label " for="helpdesk_ticket_cf_customerbusiness_phone_870937">Customer Phone</label> <div class="controls "> <input class=" required number section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_customerbusiness_phone_870937]" id="helpdesk_ticket_custom_field_cf_customerbusiness_phone_870937" /> </div>
<label class=" required control-label cf_customerbusiness_email_870937-label " for="helpdesk_ticket_cf_customerbusiness_email_870937">Customer Email</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_customerbusiness_email_870937]" id="helpdesk_ticket_custom_field_cf_customerbusiness_email_870937" /> </div>
<label class=" control-label cf_accounting_branch_870937-label " for="helpdesk_ticket_cf_accounting_branch_870937">Accounting Branch</label> <div class="controls "> <select class=" dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_accounting_branch_870937]" id="helpdesk_ticket_custom_field_cf_accounting_branch_870937"><option value="">...</option> <option data-id="42000298216" value="ALTON">ALTON</option> <option data-id="42000292955" value="ALTAMONT">ALTAMONT</option> <option data-id="42000298217" value="ARCOLA">ARCOLA</option> <option data-id="42000298218" value="BARTONVILLE">BARTONVILLE</option> <option data-id="42000298219" value="BLOOMINGTON">BLOOMINGTON</option> <option data-id="42000298220" value="BOURBONNAIS">BOURBONNAIS</option> <option data-id="42000298221" value="C CROSSING">C CROSSING</option> <option data-id="42000298222" value="C MARKETVIEW">C MARKETVIEW</option> <option data-id="42000298223" value="C W. CHURCH">C W. CHURCH</option> <option data-id="42000298224" value="CARBONDALE MAIN">CARBONDALE MAIN</option> <option data-id="42000298225" value="CARBONDALE SCHNUCKS">CARBONDALE SCHNUCKS</option> <option data-id="42000298226" value="CARMI">CARMI</option> <option data-id="42000298227" value="CARMI DRIVES">CARMI DRIVES</option> <option data-id="42000298228" value="CARTERVILLE">CARTERVILLE</option> <option data-id="42000298229" value="CHAMPAIGN CHURCH (DOWNTOWN)">CHAMPAIGN CHURCH (DOWNTOWN)</option> <option data-id="42000298230" value="CHAMPAIGN CROSSING">CHAMPAIGN CROSSING</option> <option data-id="42000298231" value="CHAMPAIGN MARKETVIEW">CHAMPAIGN MARKETVIEW</option> <option data-id="42000298232" value="CHARLESTON 6TH ST">CHARLESTON 6TH ST</option> <option data-id="42000298233" value="CHARLESTON LINCOLN">CHARLESTON LINCOLN</option> <option data-id="42000298234" value="CLAYTON">CLAYTON</option> <option data-id="42000298235" value="COLUMBIA MO -5TH">COLUMBIA MO -5TH</option> <option data-id="42000298236" value="COLUMBIA MO -FORUM">COLUMBIA MO -FORUM</option> <option data-id="42000298237" value="COLUMBIA MO- MTG CTR">COLUMBIA MO- MTG CTR</option> <option data-id="42000326015" value="CREVE COEUR MO">CREVE COEUR MO</option> <option data-id="42000298238" value="DE SOTO">DE SOTO</option> <option data-id="42000298239" value="DECATUR AIRPORT (RT 36)">DECATUR AIRPORT (RT 36)</option> <option data-id="42000298240" value="DECATUR ELDORADO">DECATUR ELDORADO</option> <option data-id="42000298241" value="DECATUR FORSYTH">DECATUR FORSYTH</option> <option data-id="42000298242" value="DECATUR MAIN (S WATER ST)">DECATUR MAIN (S WATER ST)</option> <option data-id="42000298243" value="DECATUR NORTH MAIN">DECATUR NORTH MAIN</option> <option data-id="42000298244" value="DECATUR PERSHING">DECATUR PERSHING</option> <option data-id="42000298245" value="DECATUR S FRANKLIN (S SHORES)">DECATUR S FRANKLIN (S SHORES)</option> <option data-id="42000298246" value="EDWARDSVILLE 157">EDWARDSVILLE 157</option> <option data-id="42000298247" value="EDWARDSVILLE GOSHEN">EDWARDSVILLE GOSHEN</option> <option data-id="42000298248" value="EDWARDSVILLE ST. LOUIS ST.">EDWARDSVILLE ST. LOUIS ST.</option> <option data-id="42000298249" value="EFFINGHAM">EFFINGHAM</option> <option data-id="42000298250" value="ELSBERRY MO">ELSBERRY MO</option> <option data-id="42000326016" value="EUREKA MO">EUREKA MO</option> <option data-id="42000298251" value="FAIRVIEW HEIGHTS">FAIRVIEW HEIGHTS</option> <option data-id="42000298252" value="FORSYTH">FORSYTH</option> <option data-id="42000298253" value="GALESBURG HENDERSON">GALESBURG HENDERSON</option> <option data-id="42000298254" value="GALESBURG MAIN">GALESBURG MAIN</option> <option data-id="42000298255" value="GRAPEVINE TX- MTG CTR">GRAPEVINE TX- MTG CTR</option> <option data-id="42000298256" value="GRAPEVINE TX-PREMIER">GRAPEVINE TX-PREMIER</option> <option data-id="42000298257" value="HARRISBURG MAIN (E LOCUST)">HARRISBURG MAIN (E LOCUST)</option> <option data-id="42000298258" value="HARRISBURG SOUTH (ROLLIE MOORE)">HARRISBURG SOUTH (ROLLIE MOORE)</option> <option data-id="42000298259" value="HIGHLAND BROADWAY">HIGHLAND BROADWAY</option> <option data-id="42000298260" value="HIGHLAND MAIN (ST RT 143)">HIGHLAND MAIN (ST RT 143)</option> <option data-id="42000298261" value="INDIANAPOLIS IN">INDIANAPOLIS IN</option> <option data-id="42000298262" value="JEFFERSON MO- MISSOURI">JEFFERSON MO- MISSOURI</option> <option data-id="42000298263" value="JEFFERSON MO-ELLIS">JEFFERSON MO-ELLIS</option> <option data-id="42000298264" value="JEFFERSON MO-STADIUM">JEFFERSON MO-STADIUM</option> <option data-id="42000298265" value="KNOXVILLE">KNOXVILLE</option> <option data-id="42000298266" value="LAKE ST LOUIS MO">LAKE ST LOUIS MO</option> <option data-id="42000298267" value="LAWRENCEVILLE">LAWRENCEVILLE</option> <option data-id="42000298268" value="MAHOMET">MAHOMET</option> <option data-id="42000298269" value="MANSFIELD">MANSFIELD</option> <option data-id="42000298270" value="MARION">MARION</option> <option data-id="42000298271" value="MARSHALL">MARSHALL</option> <option data-id="42000298272" value="MARTINSVILLE">MARTINSVILLE</option> <option data-id="42000298273" value="MATTOON CROSS COUNTY">MATTOON CROSS COUNTY</option> <option data-id="42000298274" value="MATTOON DRIVES">MATTOON DRIVES</option> <option data-id="42000298275" value="MATTOON MAIN (CHARLESTON AVE)">MATTOON MAIN (CHARLESTON AVE)</option> <option data-id="42000298276" value="MONTICELLO">MONTICELLO</option> <option data-id="42000298277" value="MT CARMEL">MT CARMEL</option> <option data-id="42000298278" value="MT VERNON">MT VERNON</option> <option data-id="42000298279" value="MURPHYSBORO">MURPHYSBORO</option> <option data-id="42000298280" value="NEOGA">NEOGA</option> <option data-id="42000326017" value="O'FALLON MO">O'FALLON MO</option> <option data-id="42000298281" value="OSAGE BEACH MO">OSAGE BEACH MO</option> <option data-id="42000298282" value="PARIS">PARIS</option> <option data-id="42000298283" value="PEORIA ADAMS">PEORIA ADAMS</option> <option data-id="42000298284" value="PEORIA KNOXVILLE">PEORIA KNOXVILLE</option> <option data-id="42000298285" value="PEORIA STERLING">PEORIA STERLING</option> <option data-id="42000298286" value="PEORIA UNIVERSITY">PEORIA UNIVERSITY</option> <option data-id="42000298287" value="QUINCY MAIN">QUINCY MAIN</option> <option data-id="42000298288" value="QUINCY MALL">QUINCY MALL</option> <option data-id="42000298289" value="RANTOUL">RANTOUL</option> <option data-id="42000298290" value="SAVOY">SAVOY</option> <option data-id="42000298291" value="ST CHARLES MO">ST CHARLES MO</option> <option data-id="42000298292" value="ST LOUIS MO">ST LOUIS MO</option> <option data-id="42000326018" value="ST LOUIS MO-MARKET ST">ST LOUIS MO-MARKET ST</option> <option data-id="42000326019" value="ST LOUIS MO-SOUTHFIELD CTR">ST LOUIS MO-SOUTHFIELD CTR</option> <option data-id="42000298293" value="ST PETERS MO">ST PETERS MO</option> <option data-id="42000298294" value="SULLIVAN">SULLIVAN</option> <option data-id="42000298295" value="SWANSEA">SWANSEA</option> <option data-id="42000298296" value="TAYLORVILLE">TAYLORVILLE</option> <option data-id="42000298297" value="TUSCOLA">TUSCOLA</option> <option data-id="42000298298" value="URBANA">URBANA</option> <option data-id="42000298299" value="WELDON">WELDON</option> <option data-id="42000298300" value="WINFIELD MO">WINFIELD MO</option> <option data-id="42000298301" value="WOOD RIVER">WOOD RIVER</option> <option data-id="42000347696" value="BELOIT BROAD">BELOIT BROAD</option> <option data-id="42000347697" value="JANESVILLE WI">JANESVILLE WI</option> <option data-id="42000347698" value="BELOIT CRANSTON">BELOIT CRANSTON</option> <option data-id="42000347699" value="MACHESNEY PARK">MACHESNEY PARK</option> <option data-id="42000347700" value="ROSCOE">ROSCOE</option> <option data-id="42000347701" value="ROCKFORD 11TH STREET">ROCKFORD 11TH STREET</option> <option data-id="42000347702" value="ROCKFORD PERRYVILLE">ROCKFORD PERRYVILLE</option> <option data-id="42000347703" value="ST CHARLES IL">ST CHARLES IL</option> <option data-id="42000347704" value="BELVIDERE">BELVIDERE</option> <option data-id="42000347705" value="MCHENRY">MCHENRY</option></select> </div>
<label class=" control-label cf_approval_email_870937-label " for="helpdesk_ticket_cf_approval_email_870937">Approval Email</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_approval_email_870937]" id="helpdesk_ticket_custom_field_cf_approval_email_870937" /> </div>
<label class=" required control-label cf_bsa_request_type_870937-label " for="helpdesk_ticket_cf_bsa_request_type_870937">Fraud Request Type</label> <div class="controls "> <select class=" required dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_bsa_request_type_870937]" id="helpdesk_ticket_custom_field_cf_bsa_request_type_870937"><option value="">...</option> <option data-id="42000297592" value="General Questions/Notifications">General Questions/Notifications</option> <option data-id="42000290619" value="*Report Elder Abuse">*Report Elder Abuse</option> <option data-id="42000290620" value="*Report Fraud">*Report Fraud</option> <option data-id="42000297591" value="*Report Financial Responsibility for an Organization’s Account with First Mid">*Report Financial Responsibility for an Organization’s Account with First Mid</option></select> </div>
<div class="controls"> <label class="checkbox "> <input name="helpdesk_ticket[custom_field][cf_type_with_requires_a_form_to_be_attached_870937]" type="hidden" value="0" /><input class=" checkbox section_field" id="helpdesk_ticket_custom_field_cf_type_with_requires_a_form_to_be_attached_870937_42000290697" type="checkbox" value="1" name="helpdesk_ticket[custom_field][cf_type_with_requires_a_form_to_be_attached_870937]" /> Type with * requires a form to be attached </label> </div>
<label class=" required control-label cf_customer_name_fraud_870937-label " for="helpdesk_ticket_cf_customer_name_fraud_870937">Customer Name</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_customer_name_fraud_870937]" id="helpdesk_ticket_custom_field_cf_customer_name_fraud_870937" /> </div>
<label class=" required control-label cf_account_number_fraud_870937-label " for="helpdesk_ticket_cf_account_number_fraud_870937">Account Number</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_account_number_fraud_870937]" id="helpdesk_ticket_custom_field_cf_account_number_fraud_870937" /> </div>
<label class=" required control-label cf_branch_listing_bsa_870937-label " for="helpdesk_ticket_cf_branch_listing_bsa_870937">Location</label> <div class="controls "> <select class=" required dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_branch_listing_bsa_870937]" id="helpdesk_ticket_custom_field_cf_branch_listing_bsa_870937"><option value="">...</option> <option data-id="42000298330" value="ALTAMONT">ALTAMONT</option> <option data-id="42000298321" value="ALTON">ALTON</option> <option data-id="42000298322" value="ARCOLA">ARCOLA</option> <option data-id="42000298323" value="BARTONVILLE">BARTONVILLE</option> <option data-id="42000347736" value="BELOIT BROAD">BELOIT BROAD</option> <option data-id="42000347737" value="BELOIT CRANSTON">BELOIT CRANSTON</option> <option data-id="42000347738" value="BELVIDERE">BELVIDERE</option> <option data-id="42000298324" value="BLOOMINGTON">BLOOMINGTON</option> <option data-id="42000298325" value="BOURBONNAIS">BOURBONNAIS</option> <option data-id="42000298331" value="CARBONDALE MAIN">CARBONDALE MAIN</option> <option data-id="42000298332" value="CARBONDALE SCHNUCKS">CARBONDALE SCHNUCKS</option> <option data-id="42000298333" value="CARMI">CARMI</option> <option data-id="42000298329" value="CARMI DRIVES">CARMI DRIVES</option> <option data-id="42000298334" value="CARTERVILLE">CARTERVILLE</option> <option data-id="42000298335" value="CHAMPAIGN CHURCH (DOWNTOWN)">CHAMPAIGN CHURCH (DOWNTOWN)</option> <option data-id="42000298336" value="CHAMPAIGN CROSSING">CHAMPAIGN CROSSING</option> <option data-id="42000298337" value="CHAMPAIGN MARKETVIEW">CHAMPAIGN MARKETVIEW</option> <option data-id="42000298339" value="CHARLESTON LINCOLN">CHARLESTON LINCOLN</option> <option data-id="42000298340" value="CLAYTON">CLAYTON</option> <option data-id="42000298341" value="COLUMBIA MO -5TH">COLUMBIA MO -5TH</option> <option data-id="42000298342" value="COLUMBIA MO -FORUM">COLUMBIA MO -FORUM</option> <option data-id="42000298343" value="COLUMBIA MO- MTG CTR">COLUMBIA MO- MTG CTR</option> <option data-id="42000326012" value="CREVE COEUR MO">CREVE COEUR MO</option> <option data-id="42000298344" value="DE SOTO">DE SOTO</option> <option data-id="42000298345" value="DECATUR AIRPORT (RT 36)">DECATUR AIRPORT (RT 36)</option> <option data-id="42000298346" value="DECATUR ELDORADO">DECATUR ELDORADO</option> <option data-id="42000298347" value="DECATUR FORSYTH">DECATUR FORSYTH</option> <option data-id="42000298348" value="DECATUR MAIN (S WATER ST)">DECATUR MAIN (S WATER ST)</option> <option data-id="42000298349" value="DECATUR NORTH MAIN">DECATUR NORTH MAIN</option> <option data-id="42000298350" value="DECATUR PERSHING">DECATUR PERSHING</option> <option data-id="42000298351" value="DECATUR S FRANKLIN (S SHORES)">DECATUR S FRANKLIN (S SHORES)</option> <option data-id="42000298352" value="EDWARDSVILLE 157">EDWARDSVILLE 157</option> <option data-id="42000298353" value="EDWARDSVILLE GOSHEN">EDWARDSVILLE GOSHEN</option> <option data-id="42000298354" value="EDWARDSVILLE ST. LOUIS ST.">EDWARDSVILLE ST. LOUIS ST.</option> <option data-id="42000298355" value="EFFINGHAM">EFFINGHAM</option> <option data-id="42000298356" value="ELSBERRY MO">ELSBERRY MO</option> <option data-id="42000326011" value="EUREKA MO">EUREKA MO</option> <option data-id="42000298357" value="FAIRVIEW HEIGHTS">FAIRVIEW HEIGHTS</option> <option data-id="42000298358" value="FORSYTH">FORSYTH</option> <option data-id="42000298359" value="GALESBURG HENDERSON">GALESBURG HENDERSON</option> <option data-id="42000298360" value="GALESBURG MAIN">GALESBURG MAIN</option> <option data-id="42000298361" value="GRAPEVINE TX- MTG CTR">GRAPEVINE TX- MTG CTR</option> <option data-id="42000298362" value="GRAPEVINE TX-PREMIER">GRAPEVINE TX-PREMIER</option> <option data-id="42000298363" value="HARRISBURG MAIN (E LOCUST)">HARRISBURG MAIN (E LOCUST)</option> <option data-id="42000298364" value="HARRISBURG SOUTH (ROLLIE MOORE)">HARRISBURG SOUTH (ROLLIE MOORE)</option> <option data-id="42000298365" value="HIGHLAND BROADWAY">HIGHLAND BROADWAY</option> <option data-id="42000298366" value="HIGHLAND MAIN (ST RT 143)">HIGHLAND MAIN (ST RT 143)</option> <option data-id="42000298367" value="INDIANAPOLIS IN">INDIANAPOLIS IN</option> <option data-id="42000347739" value="JANESVILLE WI">JANESVILLE WI</option> <option data-id="42000298368" value="JEFFERSON MO- MISSOURI">JEFFERSON MO- MISSOURI</option> <option data-id="42000298369" value="JEFFERSON MO-ELLIS">JEFFERSON MO-ELLIS</option> <option data-id="42000298370" value="JEFFERSON MO-STADIUM">JEFFERSON MO-STADIUM</option> <option data-id="42000298371" value="KNOXVILLE">KNOXVILLE</option> <option data-id="42000298372" value="LAKE ST LOUIS MO">LAKE ST LOUIS MO</option> <option data-id="42000298373" value="LAWRENCEVILLE">LAWRENCEVILLE</option> <option data-id="42000347740" value="MACHESNEY PARK">MACHESNEY PARK</option> <option data-id="42000298374" value="MAHOMET">MAHOMET</option> <option data-id="42000298375" value="MANSFIELD">MANSFIELD</option> <option data-id="42000298376" value="MARION">MARION</option> <option data-id="42000298377" value="MARSHALL">MARSHALL</option> <option data-id="42000298378" value="MARTINSVILLE">MARTINSVILLE</option> <option data-id="42000347409" value="MATTOON CORPORATE">MATTOON CORPORATE</option> <option data-id="42000298379" value="MATTOON CROSS COUNTY">MATTOON CROSS COUNTY</option> <option data-id="42000298380" value="MATTOON DRIVES">MATTOON DRIVES</option> <option data-id="42000298381" value="MATTOON MAIN (CHARLESTON AVE)">MATTOON MAIN (CHARLESTON AVE)</option> <option data-id="42000347741" value="MCHENRY">MCHENRY</option> <option data-id="42000298382" value="MONTICELLO">MONTICELLO</option> <option data-id="42000298383" value="MT CARMEL">MT CARMEL</option> <option data-id="42000298384" value="MT VERNON">MT VERNON</option> <option data-id="42000298385" value="MURPHYSBORO">MURPHYSBORO</option> <option data-id="42000298386" value="NEOGA">NEOGA</option> <option data-id="42000326010" value="O'FALLON MO">O'FALLON MO</option> <option data-id="42000298387" value="OSAGE BEACH MO">OSAGE BEACH MO</option> <option data-id="42000298388" value="PARIS">PARIS</option> <option data-id="42000298389" value="PEORIA ADAMS">PEORIA ADAMS</option> <option data-id="42000298390" value="PEORIA KNOXVILLE">PEORIA KNOXVILLE</option> <option data-id="42000298391" value="PEORIA STERLING">PEORIA STERLING</option> <option data-id="42000298392" value="PEORIA UNIVERSITY">PEORIA UNIVERSITY</option> <option data-id="42000298393" value="QUINCY MAIN">QUINCY MAIN</option> <option data-id="42000298394" value="QUINCY MALL">QUINCY MALL</option> <option data-id="42000298395" value="RANTOUL">RANTOUL</option> <option data-id="42000347742" value="ROCKFORD 11TH STREET">ROCKFORD 11TH STREET</option> <option data-id="42000347743" value="ROCKFORD PERRYVILLE">ROCKFORD PERRYVILLE</option> <option data-id="42000347744" value="ROSCOE">ROSCOE</option> <option data-id="42000298396" value="SAVOY">SAVOY</option> <option data-id="42000347745" value="ST CHARLES IL">ST CHARLES IL</option> <option data-id="42000298397" value="ST CHARLES MO">ST CHARLES MO</option> <option data-id="42000298398" value="ST LOUIS MO">ST LOUIS MO</option> <option data-id="42000326014" value="ST LOUIS MO-MARKET ST">ST LOUIS MO-MARKET ST</option> <option data-id="42000326013" value="ST LOUIS MO-SOUTHFIELD CTR">ST LOUIS MO-SOUTHFIELD CTR</option> <option data-id="42000298399" value="ST PETERS MO">ST PETERS MO</option> <option data-id="42000298400" value="SULLIVAN">SULLIVAN</option> <option data-id="42000298401" value="SWANSEA">SWANSEA</option> <option data-id="42000298402" value="TAYLORVILLE">TAYLORVILLE</option> <option data-id="42000298403" value="TUSCOLA">TUSCOLA</option> <option data-id="42000298404" value="URBANA">URBANA</option> <option data-id="42000298405" value="WELDON">WELDON</option> <option data-id="42000298406" value="WINFIELD MO">WINFIELD MO</option> <option data-id="42000298407" value="WOOD RIVER">WOOD RIVER</option></select> </div>
<label class=" required control-label cf_branch_employee_bsa_870937-label " for="helpdesk_ticket_cf_branch_employee_bsa_870937">Branch Employee</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_branch_employee_bsa_870937]" id="helpdesk_ticket_custom_field_cf_branch_employee_bsa_870937" /> </div>
<div class="controls"> <label class="checkbox "> <input name="helpdesk_ticket[custom_field][cf_email_reminder_870937]" type="hidden" value="0" /><input class=" checkbox section_field" id="helpdesk_ticket_custom_field_cf_email_reminder_870937_42000290697" type="checkbox" value="1" name="helpdesk_ticket[custom_field][cf_email_reminder_870937]" /> ONLY ONE VALID EMAIL ADDRESS </label> </div>
<label class=" required control-label cf_branch_mgr_email_870937-label " for="helpdesk_ticket_cf_branch_mgr_email_870937">Branch Mgr. EMAIL (Requires ONE Valid Email)</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_branch_mgr_email_870937]" id="helpdesk_ticket_custom_field_cf_branch_mgr_email_870937" /> </div>
<label class=" required control-label cf_regional_mgr_email_fraud_870937-label " for="helpdesk_ticket_cf_regional_mgr_email_fraud_870937">Regional Mgr Email</label> <div class="controls "> <select class=" required dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_regional_mgr_email_fraud_870937]" id="helpdesk_ticket_custom_field_cf_regional_mgr_email_fraud_870937"><option value="">...</option> <option data-id="42000297593" value="AHarroun@firstmid.com">AHarroun@firstmid.com</option> <option data-id="42000297594" value="BCougill@firstmid.com">BCougill@firstmid.com</option> <option data-id="42000321459" value="bswensen@firstmid.com">bswensen@firstmid.com</option> <option data-id="42000297595" value="DThomas@firstmid.com">DThomas@firstmid.com</option> <option data-id="42000297596" value="EWalters@firstmid.com">EWalters@firstmid.com</option> <option data-id="42000330383" value="jeffrey.dulle@firstmid.com">jeffrey.dulle@firstmid.com</option> <option data-id="42000353675" value="Mathew.Reynolds@firstmid.com">Mathew.Reynolds@firstmid.com</option> <option data-id="42000321458" value="MiWhite@firstmid.com">MiWhite@firstmid.com</option> <option data-id="42000327930" value="mschultz@firstmid.com">mschultz@firstmid.com</option> <option data-id="42000297597" value="julie.bryant@firstmid.com">julie.bryant@firstmid.com</option> <option data-id="42000297598" value="STuetken@firstmid.com">STuetken@firstmid.com</option></select> </div>
<div class="controls"> <label class="checkbox "> <input name="helpdesk_ticket[custom_field][cf_attach_screenshot_of_results_870937]" type="hidden" value="0" /><input class=" checkbox section_field" id="helpdesk_ticket_custom_field_cf_attach_screenshot_of_results_870937_42000295048" type="checkbox" value="1" name="helpdesk_ticket[custom_field][cf_attach_screenshot_of_results_870937]" /> Attach Screenshot of Results </label> </div>
<label class=" control-label cf_date_of_cash_transaction_870937-label " for="helpdesk_ticket_cf_date_of_cash_transaction_870937">Date of Match</label> <div class="controls support-date-field "> <input type="text" name="helpdesk_ticket[custom_field][cf_date_of_cash_transaction_870937]" id="helpdesk_ticket_custom_field_cf_date_of_cash_transaction_870937" class=" date section_field datepicker_popover" readonly="readonly" data-show-image="true" data-date-format="d M, yy" placeholder="" /> </div>
<label class=" control-label cf_conductors_name_870937-label " for="helpdesk_ticket_cf_conductors_name_870937">Organization or Individual's Name</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_conductors_name_870937]" id="helpdesk_ticket_custom_field_cf_conductors_name_870937" /> </div>
<label class=" control-label cf_account_number_bsa_870937-label " for="helpdesk_ticket_cf_account_number_bsa_870937">Contact Number</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_account_number_bsa_870937]" id="helpdesk_ticket_custom_field_cf_account_number_bsa_870937" /> </div>
<label class=" required control-label cf_request_870937-label " for="helpdesk_ticket_cf_request_870937">Request</label> <div class="controls "> <select class=" required dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_request_870937]" id="helpdesk_ticket_custom_field_cf_request_870937"><option value="">...</option> <option data-id="42000243544" value="Refunds">Refunds</option> <option data-id="42000243545" value="Restart Agreement">Restart Agreement</option> <option data-id="42000243546" value="Bad Address Removal">Bad Address Removal</option></select> </div>
<label class=" required control-label cf_branch_name_870937-label " for="helpdesk_ticket_cf_branch_name_870937">Branch Name</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_branch_name_870937]" id="helpdesk_ticket_custom_field_cf_branch_name_870937" /> </div>
<label class=" control-label cf_branch_employee_870937-label " for="helpdesk_ticket_cf_branch_employee_870937">Branch Employee</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_branch_employee_870937]" id="helpdesk_ticket_custom_field_cf_branch_employee_870937" /> </div>
<label class=" required control-label cf_customer_name_2_870937-label " for="helpdesk_ticket_cf_customer_name_2_870937">Customer Name</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_customer_name_2_870937]" id="helpdesk_ticket_custom_field_cf_customer_name_2_870937" /> </div>
<label class=" required control-label cf_customer_account_number_870937-label " for="helpdesk_ticket_cf_customer_account_number_870937">Customer Account Number</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_customer_account_number_870937]" id="helpdesk_ticket_custom_field_cf_customer_account_number_870937" /> </div>
<label class=" required control-label cf_bsc_request_types_870937-label " for="helpdesk_ticket_cf_bsc_request_types_870937">BSC Request Types</label> <div class="controls "> <select class=" required dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_bsc_request_types_870937]" id="helpdesk_ticket_custom_field_cf_bsc_request_types_870937"><option value="">...</option> <option data-id="42000298641" value="Research Request">Research Request</option></select> </div>
<label class=" control-label cf_customer_port_number_870937-label " for="helpdesk_ticket_cf_customer_port_number_870937">Customer Port Number</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_customer_port_number_870937]" id="helpdesk_ticket_custom_field_cf_customer_port_number_870937" /> </div>
<label class=" control-label cf_customer_name70036_870937-label " for="helpdesk_ticket_cf_customer_name70036_870937">Customer Name</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_customer_name70036_870937]" id="helpdesk_ticket_custom_field_cf_customer_name70036_870937" /> </div>
<label class=" control-label cf_customer_tax_id_870937-label " for="helpdesk_ticket_cf_customer_tax_id_870937">Customer Tax ID </label> <div class="controls "> <input class=" number section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_customer_tax_id_870937]" id="helpdesk_ticket_custom_field_cf_customer_tax_id_870937" /> </div>
<label class=" control-label cf_customer_account_number337374_870937-label " for="helpdesk_ticket_cf_customer_account_number337374_870937">Customer Account Number</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_customer_account_number337374_870937]" id="helpdesk_ticket_custom_field_cf_customer_account_number337374_870937" /> </div>
<label class=" control-label cf_beginning_research_date_870937-label " for="helpdesk_ticket_cf_beginning_research_date_870937">Beginning Research Date</label> <div class="controls support-date-field "> <input type="text" name="helpdesk_ticket[custom_field][cf_beginning_research_date_870937]" id="helpdesk_ticket_custom_field_cf_beginning_research_date_870937" class=" date section_field datepicker_popover" readonly="readonly" data-show-image="true" data-date-format="d M, yy" placeholder="" /> </div>
<label class=" control-label cf_ending_research_date_870937-label " for="helpdesk_ticket_cf_ending_research_date_870937">Ending Research Date</label> <div class="controls support-date-field "> <input type="text" name="helpdesk_ticket[custom_field][cf_ending_research_date_870937]" id="helpdesk_ticket_custom_field_cf_ending_research_date_870937" class=" date section_field datepicker_popover" readonly="readonly" data-show-image="true" data-date-format="d M, yy" placeholder="" /> </div>
<label class=" control-label cf_document_type841692_870937-label " for="helpdesk_ticket_cf_document_type841692_870937">Document Type</label> <div class="controls "> <select class=" dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_document_type841692_870937]" id="helpdesk_ticket_custom_field_cf_document_type841692_870937"><option value="">...</option> <option data-id="42000319693" value="HSA Application">HSA Application</option> <option data-id="42000334828" value="IRA Form">IRA Form</option></select> </div>
<label class=" required control-label cf_document_type_870937-label " for="helpdesk_ticket_cf_document_type_870937">Document Type</label> <div class="controls "> <select class=" required dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_document_type_870937]" id="helpdesk_ticket_custom_field_cf_document_type_870937"><option value="">...</option> <option data-id="42000322445" value="Other (DO NOT SUBMIT A POA, SEA , Trust etc)">Other (DO NOT SUBMIT A POA, SEA , Trust etc)</option> <option data-id="42000339938" value="Account Acknowledgement Form">Account Acknowledgement Form</option> <option data-id="42000354759" value="BH Secured Card">BH Secured Card</option> <option data-id="42000203064" value="Citation">Citation</option> <option data-id="42000203066" value="Garnishment">Garnishment</option> <option data-id="42000203065" value="Levy">Levy</option> <option data-id="42000203067" value="Subpoena">Subpoena</option> <option data-id="42000332725" value="Tax Form Reprint/Correction">Tax Form Reprint/Correction</option> <option data-id="42000268066" value="W-8 or W-9">W-8 or W-9</option></select> </div>
<label class=" required control-label cf_date_received_870937-label " for="helpdesk_ticket_cf_date_received_870937">Date Received</label> <div class="controls support-date-field "> <input type="text" name="helpdesk_ticket[custom_field][cf_date_received_870937]" id="helpdesk_ticket_custom_field_cf_date_received_870937" class=" required date section_field datepicker_popover" readonly="readonly" data-show-image="true" data-date-format="d M, yy" placeholder="" /> </div>
<div class="controls"> <label class="checkbox "> <input name="helpdesk_ticket[custom_field][cf_bh_secured_card_870937]" type="hidden" value="0" /><input class=" checkbox section_field" id="helpdesk_ticket_custom_field_cf_bh_secured_card_870937_42000333579" type="checkbox" value="1" name="helpdesk_ticket[custom_field][cf_bh_secured_card_870937]" /> Please include name, last 4 of credit card, and last 4 of social for Secured Cards </label> </div>
<label class=" required control-label cf_ts_request_types_870937-label " for="helpdesk_ticket_cf_ts_request_types_870937">Support Needed</label> <div class="controls "> <select class=" required dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_ts_request_types_870937]" id="helpdesk_ticket_custom_field_cf_ts_request_types_870937"><option value="">...</option> <option data-id="42000330502" value="ACH FF/Check Positive Pay Support">ACH FF/Check Positive Pay Support</option> <option data-id="42000330501" value="ACH Origination Support">ACH Origination Support</option> <option data-id="42000317085" value="Activation Key/Unlock Token">Activation Key/Unlock Token</option> <option data-id="42000330878" value="Analysis Fee Adjustment">Analysis Fee Adjustment</option> <option data-id="42000354073" value="Bill Pay">Bill Pay</option> <option data-id="42000334435" value="Document Prep Request from TM">Document Prep Request from TM</option> <option data-id="42000317084" value="General Support">General Support</option> <option data-id="42000341497" value="Mobile App/Mobile Deposit">Mobile App/Mobile Deposit</option> <option data-id="42000317083" value="Onboarding">Onboarding</option> <option data-id="42000341498" value="QuickBooks Assistance">QuickBooks Assistance</option> <option data-id="42000330503" value="Remote Deposit Support">Remote Deposit Support</option> <option data-id="42000333419" value="Secure Browser Assistance">Secure Browser Assistance</option> <option data-id="42000333558" value="Secure Browser Update Assistance">Secure Browser Update Assistance</option> <option data-id="42000338970" value="Statement/Research Request">Statement/Research Request</option> <option data-id="42000328560" value="Temporary Limit Increase (ACH/Wire)">Temporary Limit Increase (ACH/Wire)</option> <option data-id="42000338817" value="TM Setup">TM Setup</option> <option data-id="42000330504" value="Wire Transfer Support">Wire Transfer Support</option> <option data-id="42000347477" value="Blackhawk - ACH (file, templates, payees, etc.)">Blackhawk - ACH (file, templates, payees, etc.)</option> <option data-id="42000347478" value="Blackhawk - non-TM Request">Blackhawk - non-TM Request</option> <option data-id="42000347479" value="Blackhawk - Online Banking Installation/Navigation">Blackhawk - Online Banking Installation/Navigation</option> <option data-id="42000347638" value="Blackhawk - Positive Pay">Blackhawk - Positive Pay</option> <option data-id="42000347480" value="Blackhawk - Remote Deposit">Blackhawk - Remote Deposit</option> <option data-id="42000347481" value="Blackhawk - Research Request">Blackhawk - Research Request</option> <option data-id="42000347482" value="Blackhawk - Wires">Blackhawk - Wires</option></select> </div>
<label class=" required control-label cf_tscustomer_name_870937-label " for="helpdesk_ticket_cf_tscustomer_name_870937">Customer Name</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_tscustomer_name_870937]" id="helpdesk_ticket_custom_field_cf_tscustomer_name_870937" /> </div>
<label class=" required control-label cf_ts_account_number812331_870937-label " for="helpdesk_ticket_cf_ts_account_number812331_870937">Account Number(s)</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_ts_account_number812331_870937]" id="helpdesk_ticket_custom_field_cf_ts_account_number812331_870937" /> </div>
<label class=" required control-label cf_tscustomer_name_870937-label " for="helpdesk_ticket_cf_tscustomer_name_870937">Customer Name</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_tscustomer_name_870937]" id="helpdesk_ticket_custom_field_cf_tscustomer_name_870937" /> </div>
<label class=" required control-label cf_ts_account_number812331_870937-label " for="helpdesk_ticket_cf_ts_account_number812331_870937">Account Number(s)</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_ts_account_number812331_870937]" id="helpdesk_ticket_custom_field_cf_ts_account_number812331_870937" /> </div>
<label class=" control-label cf_remote_deposit_870937-label " for="helpdesk_ticket_cf_remote_deposit_870937">Remote Deposit Capture </label> <div class="controls nested_field "> <select class=" nested_field section_field" id="helpdesk_ticket_custom_field_cf_remote_deposit_870937_42000354151" name="helpdesk_ticket[custom_field][cf_remote_deposit_870937]"><option value="">...</option> <option value="Multi-feed Scanner">Multi-feed Scanner</option> <option value="Single-feed Scanner">Single-feed Scanner</option></select><div class="level_2"><label class="">Equipment Location</label><select class=" nested_field section_field" id="helpdesk_ticket_custom_field_cf_scanner_type_870937_42000354151" name="helpdesk_ticket[custom_field][cf_scanner_type_870937]"><option value="">...</option> </select></div><div class="level_3"><label class="">Support </label><select class=" nested_field section_field" id="helpdesk_ticket_custom_field_cf_equipment_location_870937_42000354151" name="helpdesk_ticket[custom_field][cf_equipment_location_870937]"><option value="">...</option> </select></div><script> //<![CDATA[ jQuery('#helpdesk_ticket_custom_field_cf_remote_deposit_870937_42000354151').nested_select_tag({"data_tree":[["Multi-feed Scanner","Multi-feed Scanner",[["Ship to address on file","Ship to address on file",[["Training needed","Training needed"],["Existing customer","Existing customer"]]],["Alternate Address","Alternate Address",[["Training needed","Training needed"],["Existing customer","Existing customer"]]]]],["Single-feed Scanner","Single-feed Scanner",[["Ship to address on file","Ship to address on file",[["Training needed","Training needed"],["Existing customer","Existing customer"]]],["Alternate Address","Alternate Address",[]]]]],"initValues":null,"disable_children":false,"include_blank":"...","selected":null,"pl_value_id":"42000354151","subcategory_id":"helpdesk_ticket_custom_field_cf_scanner_type_870937_42000354151","item_id":"helpdesk_ticket_custom_field_cf_equipment_location_870937_42000354151"}); //]]> </script> </div>
<label class=" control-label cf_ach_origination_870937-label " for="helpdesk_ticket_cf_ach_origination_870937">ACH Origination </label> <div class="controls nested_field "> <select class=" nested_field section_field" id="helpdesk_ticket_custom_field_cf_ach_origination_870937_42000354151" name="helpdesk_ticket[custom_field][cf_ach_origination_870937]"><option value="">...</option> <option value="Credit">Credit</option> <option value="Debit">Debit</option> <option value="Both">Both</option></select><div class="level_2"><label class="">SEC Codes </label><select class=" nested_field section_field" id="helpdesk_ticket_custom_field_cf_pricing910683_870937_42000354151" name="helpdesk_ticket[custom_field][cf_pricing910683_870937]"><option value="">...</option> </select></div><div class="level_3"><label class="">Debit SEC Code(s)</label><select class=" nested_field section_field" id="helpdesk_ticket_custom_field_cf_ach_type_870937_42000354151" name="helpdesk_ticket[custom_field][cf_ach_type_870937]"><option value="">...</option> </select></div><script> //<![CDATA[ jQuery('#helpdesk_ticket_custom_field_cf_ach_origination_870937_42000354151').nested_select_tag({"data_tree":[["Credit","Credit",[["Individual (PPD)/Payroll (PPD)","Individual (PPD)/Payroll (PPD)",[]],["Business (CCD)","Business (CCD)",[]],["All the above","All the above",[]]]],["Debit","Debit",[["Physical Authorization (PPD)","Physical Authorization (PPD)",[]],["80 Addenda (CCD)","80 Addenda (CCD)",[]],["Extended Addenda (CTX)","Extended Addenda (CTX)",[]],["Physical Authorization (PPD) & 80 Addenda (CCD)","Physical Authorization (PPD) & 80 Addenda (CCD)",[]],["Physical Authorization (PPD), 80 Addenda (CCD) and Extended Addenda (CTX)","Physical Authorization (PPD), 80 Addenda (CCD) and Extended Addenda (CTX)",[]]]],["Both","Both",[["Individual/Payroll (PPD)","Individual/Payroll (PPD)",[["Physical Authorization (PPD)","Physical Authorization (PPD)"],["80 Addenda (CCD)","80 Addenda (CCD)"],["Extended Addenda (CTX)","Extended Addenda (CTX)"],["Physical Authorization (PPD) & 80 Addenda (CCD)","Physical Authorization (PPD) & 80 Addenda (CCD)"],["Physical Authorization (PPD), 80 Addenda (CCD) & Extended Addenda (CTX)","Physical Authorization (PPD), 80 Addenda (CCD) & Extended Addenda (CTX)"],["All the above","All the above"]]],["Individual (PPD) & Business (CCD)","Individual (PPD) & Business (CCD)",[["Physical Authorization (PPD)","Physical Authorization (PPD)"],["80 Addenda (CCD)","80 Addenda (CCD)"],["Extended Addenda (CTX)","Extended Addenda (CTX)"],["Physical Authorization (PPD) & 80 Addenda (CCD)","Physical Authorization (PPD) & 80 Addenda (CCD)"],["Physical Authorization (PPD), 80 Addenda (CCD) & Extended Addenda (CTX)","Physical Authorization (PPD), 80 Addenda (CCD) & Extended Addenda (CTX)"],["All the above","All the above"]]],["All the above","All the above",[["Physical Authorization (PPD)","Physical Authorization (PPD)"],["80 Addenda (CCD)","80 Addenda (CCD)"],["Extended Addenda (CTX)","Extended Addenda (CTX)"],["Physical Authorization (PPD) & 80 Addenda (CCD)","Physical Authorization (PPD) & 80 Addenda (CCD)"],["Physical Authorization (PPD), 80 Addenda (CCD) & Extended Addenda (CTX)","Physical Authorization (PPD), 80 Addenda (CCD) & Extended Addenda (CTX)"],["All the above","All the above"]]]]]],"initValues":null,"disable_children":false,"include_blank":"...","selected":null,"pl_value_id":"42000354151","subcategory_id":"helpdesk_ticket_custom_field_cf_pricing910683_870937_42000354151","item_id":"helpdesk_ticket_custom_field_cf_ach_type_870937_42000354151"}); //]]> </script> </div>
<label class=" control-label cf_ts_rdcach_limit_870937-label " for="helpdesk_ticket_cf_ts_rdcach_limit_870937">RDC/ACH Limit (if applicable) </label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_ts_rdcach_limit_870937]" id="helpdesk_ticket_custom_field_cf_ts_rdcach_limit_870937" /> </div>
<label class=" control-label cf_ts_nature_of_business_870937-label " for="helpdesk_ticket_cf_ts_nature_of_business_870937">Nature of Business (needed for RDC/ACH)</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_ts_nature_of_business_870937]" id="helpdesk_ticket_custom_field_cf_ts_nature_of_business_870937" /> </div>
<label class=" control-label cf_wire_origination914049_870937-label " for="helpdesk_ticket_cf_wire_origination914049_870937">Wire Origination </label> <div class="controls nested_field "> <select class=" nested_field section_field" id="helpdesk_ticket_custom_field_cf_wire_origination914049_870937_42000354151" name="helpdesk_ticket[custom_field][cf_wire_origination914049_870937]"><option value="">...</option> <option value="Domestic/International">Domestic/International</option> <option value="Domestic/International and Foreign Exchange">Domestic/International and Foreign Exchange</option></select><div class="level_2"><label class="">Purpose of Wire </label><select class=" nested_field section_field" id="helpdesk_ticket_custom_field_cf_wire_types_870937_42000354151" name="helpdesk_ticket[custom_field][cf_wire_types_870937]"><option value="">...</option> </select></div><div class="level_3"><label class="">Daily Wire Limit </label><select class=" nested_field section_field" id="helpdesk_ticket_custom_field_cf_purpose_of_wires_870937_42000354151" name="helpdesk_ticket[custom_field][cf_purpose_of_wires_870937]"><option value="">...</option> </select></div><script> //<![CDATA[ jQuery('#helpdesk_ticket_custom_field_cf_wire_origination914049_870937_42000354151').nested_select_tag({"data_tree":[["Domestic/International","Domestic/International",[["Payroll","Payroll",[["$10,000.00","$10,000.00"],["$20,000.00","$20,000.00"],["$30,000.00","$30,000.00"],["$40,000.00","$40,000.00"],["$50,000.00","$50,000.00"],["$60,000.00","$60,000.00"],["$70,000.00","$70,000.00"],["$80,000.00","$80,000.00"],["$90,000.00","$90,000.00"],["$100,000.00","$100,000.00"],["$110,000.00","$110,000.00"],["$120,000.00","$120,000.00"],["$130,000.00","$130,000.00"],["$140,000.00","$140,000.00"],["$150,000.00","$150,000.00"],["$160,000.00","$160,000.00"],["$170,000.00","$170,000.00"],["$180,000.00","$180,000.00"],["$190,000.00","$190,000.00"],["$200,000.00","$200,000.00"]]],["Vendor Payments/Invoices","Vendor Payments/Invoices",[["$10,000.00","$10,000.00"],["$20,000.00","$20,000.00"],["$30,000.00","$30,000.00"],["$40,000.00","$40,000.00"],["$50,000.00","$50,000.00"],["$60,000.00","$60,000.00"],["$70,000.00","$70,000.00"],["$80,000.00","$80,000.00"],["$90,000.00","$90,000.00"],["$100,000.00","$100,000.00"],["$110,000.00","$110,000.00"],["$120,000.00","$120,000.00"],["$130,000.00","$130,000.00"],["$140,000.00","$140,000.00"],["$150,000.00","$150,000.00"],["$160,000.00","$160,000.00"],["$170,000.00","$170,000.00"],["$180,000.00","$180,000.00"],["$190,000.00","$190,000.00"],["$200,000.00","$200,000.00"]]],["Taxes","Taxes",[["$10,000.00","$10,000.00"],["$20,000.00","$20,000.00"],["$30,000.00","$30,000.00"],["$40,000.00","$40,000.00"],["$50,000.00","$50,000.00"],["$60,000.00","$60,000.00"],["$70,000.00","$70,000.00"],["$80,000.00","$80,000.00"],["$90,000.00","$90,000.00"],["$100,000.00","$100,000.00"],["$110,000.00","$110,000.00"],["$120,000.00","$120,000.00"],["$130,000.00","$130,000.00"],["$140,000.00","$140,000.00"],["$150,000.00","$150,000.00"],["$160,000.00","$160,000.00"],["$170,000.00","$170,000.00"],["$180,000.00","$180,000.00"],["$190,000.00","$190,000.00"],["$200,000.00","$200,000.00"],["$300,000.00","$300,000.00"],["$400,000.00","$400,000.00"],["$500,000.00","$500,000.00"]]],["All of the above","All of the above",[["$10,000.00","$10,000.00"],["$20,000.00","$20,000.00"],["$30,000.00","$30,000.00"],["$40,000.00","$40,000.00"],["$50,000.00","$50,000.00"],["$60,000.00","$60,000.00"],["$70,000.00","$70,000.00"],["$80,000.00","$80,000.00"],["$90,000.00","$90,000.00"],["$100,000.00","$100,000.00"],["$110,000.00","$110,000.00"],["$120,000.00","$120,000.00"],["$130,000.00","$130,000.00"],["$140,000.00","$140,000.00"],["$150,000.00","$150,000.00"],["$160,000.00","$160,000.00"],["$170,000.00","$170,000.00"],["$180,000.00","$180,000.00"],["$190,000.00","$190,000.00"],["$200,000.00","$200,000.00"],["$300,000.00","$300,000.00"],["$400,000.00","$400,000.00"],["$500,000.00","$500,000.00"]]]]],["Domestic/International and Foreign Exchange","Domestic/International and Foreign Exchange",[["Payroll","Payroll",[["$10,000.00","$10,000.00"],["$20,000.00","$20,000.00"],["$30,000.00","$30,000.00"],["$40,000.00","$40,000.00"],["$50,000.00","$50,000.00"],["$60,000.00","$60,000.00"],["$70,000.00","$70,000.00"],["$80,000.00","$80,000.00"],["$90,000.00","$90,000.00"],["$100,000.00","$100,000.00"],["$110,000.00","$110,000.00"],["$120,000.00","$120,000.00"],["$130,000.00","$130,000.00"],["$140,000.00","$140,000.00"],["$150,000.00","$150,000.00"],["$160,000.00","$160,000.00"],["$170,000.00","$170,000.00"],["$180,000.00","$180,000.00"],["$190,000.00","$190,000.00"],["$200,000.00","$200,000.00"]]],["Vendor Payments/Invoices","Vendor Payments/Invoices",[["$10,000.00","$10,000.00"],["$20,000.00","$20,000.00"],["$30,000.00","$30,000.00"],["$40,000.00","$40,000.00"],["$50,000.00","$50,000.00"],["$60,000.00","$60,000.00"],["$70,000.00","$70,000.00"],["$80,000.00","$80,000.00"],["$90,000.00","$90,000.00"],["$100,000.00","$100,000.00"],["$110,000.00","$110,000.00"],["$120,000.00","$120,000.00"],["$130,000.00","$130,000.00"],["$140,000.00","$140,000.00"],["$150,000.00","$150,000.00"],["$160,000.00","$160,000.00"],["$170,000.00","$170,000.00"],["$180,000.00","$180,000.00"],["$190,000.00","$190,000.00"],["$200,000.00","$200,000.00"]]],["Taxes","Taxes",[["$10,000.00","$10,000.00"],["$20,000.00","$20,000.00"],["$30,000.00","$30,000.00"],["$40,000.00","$40,000.00"],["$50,000.00","$50,000.00"],["$60,000.00","$60,000.00"],["$70,000.00","$70,000.00"],["$80,000.00","$80,000.00"],["$90,000.00","$90,000.00"],["$100,000.00","$100,000.00"],["$110,000.00","$110,000.00"],["$120,000.00","$120,000.00"],["$130,000.00","$130,000.00"],["$140,000.00","$140,000.00"],["$150,000.00","$150,000.00"],["$160,000.00","$160,000.00"],["$170,000.00","$170,000.00"],["$180,000.00","$180,000.00"],["$190,000.00","$190,000.00"],["$200,000.00","$200,000.00"],["$300,000.00","$300,000.00"],["$400,000.00","$400,000.00"],["$500,000.00","$500,000.00"]]],["All of the Above","All of the Above",[["$10,000.00","$10,000.00"],["$20,000.00","$20,000.00"],["$30,000.00","$30,000.00"],["$40,000.00","$40,000.00"],["$50,000.00","$50,000.00"],["$60,000.00","$60,000.00"],["$70,000.00","$70,000.00"],["$80,000.00","$80,000.00"],["$90,000.00","$90,000.00"],["$100,000.00","$100,000.00"],["$110,000.00","$110,000.00"],["$120,000.00","$120,000.00"],["$130,000.00","$130,000.00"],["$140,000.00","$140,000.00"],["$150,000.00","$150,000.00"],["$160,000.00","$160,000.00"],["$170,000.00","$170,000.00"],["$180,000.00","$180,000.00"],["$190,000.00","$190,000.00"],["$200,000.00","$200,000.00"],["$300,000.00","$300,000.00"],["$400,000.00","$400,000.00"],["$500,000.00","$500,000.00"]]]]]],"initValues":null,"disable_children":false,"include_blank":"...","selected":null,"pl_value_id":"42000354151","subcategory_id":"helpdesk_ticket_custom_field_cf_wire_types_870937_42000354151","item_id":"helpdesk_ticket_custom_field_cf_purpose_of_wires_870937_42000354151"}); //]]> </script> </div>
<label class=" control-label cf_check_positive_pay_870937-label " for="helpdesk_ticket_cf_check_positive_pay_870937">Check Positive Pay </label> <div class="controls nested_field "> <select class=" nested_field section_field" id="helpdesk_ticket_custom_field_cf_check_positive_pay_870937_42000354151" name="helpdesk_ticket[custom_field][cf_check_positive_pay_870937]"><option value="">...</option> <option value="Pay (if no decision by 12:00 CST)">Pay (if no decision by 12:00 CST)</option> <option value="Return (if no decision by 12:00 CST)">Return (if no decision by 12:00 CST)</option></select><div class="level_2"><label class="">File Entry Method </label><select class=" nested_field section_field" id="helpdesk_ticket_custom_field_cf_default_decision_870937_42000354151" name="helpdesk_ticket[custom_field][cf_default_decision_870937]"><option value="">...</option> </select></div><script> //<![CDATA[ jQuery('#helpdesk_ticket_custom_field_cf_check_positive_pay_870937_42000354151').nested_select_tag({"data_tree":[["Pay (if no decision by 12:00 CST)","Pay (if no decision by 12:00 CST)",[["Customer will manually enter items","Customer will manually enter items",[]],["File Upload - Mapper needed","File Upload - Mapper needed",[]]]],["Return (if no decision by 12:00 CST)","Return (if no decision by 12:00 CST)",[["Customer will manually enter items","Customer will manually enter items",[]],["File Upload - Mapper needed","File Upload - Mapper needed",[]]]]],"initValues":null,"disable_children":false,"include_blank":"...","selected":null,"pl_value_id":"42000354151","subcategory_id":"helpdesk_ticket_custom_field_cf_default_decision_870937_42000354151"}); //]]> </script> </div>
<label class=" control-label cf_ach_fraud_filter_870937-label " for="helpdesk_ticket_cf_ach_fraud_filter_870937">ACH Fraud Filter </label> <div class="controls nested_field "> <select class=" nested_field section_field" id="helpdesk_ticket_custom_field_cf_ach_fraud_filter_870937_42000354151" name="helpdesk_ticket[custom_field][cf_ach_fraud_filter_870937]"><option value="">...</option> <option value="Pay (if no decision by 12:00 CST)">Pay (if no decision by 12:00 CST)</option> <option value="Return (if no decision by 12:00 CST)">Return (if no decision by 12:00 CST)</option></select><div class="level_2"><label class="">Filter Type </label><select class=" nested_field section_field" id="helpdesk_ticket_custom_field_cf_default_decision363114_870937_42000354151" name="helpdesk_ticket[custom_field][cf_default_decision363114_870937]"><option value="">...</option> </select></div><script> //<![CDATA[ jQuery('#helpdesk_ticket_custom_field_cf_ach_fraud_filter_870937_42000354151').nested_select_tag({"data_tree":[["Pay (if no decision by 12:00 CST)","Pay (if no decision by 12:00 CST)",[["Debit ACH FF Only (most common)","Debit ACH FF Only (most common)",[]],["Credit ACH FF Only (rare)","Credit ACH FF Only (rare)",[]],["Credit & Debit ACH FF","Credit & Debit ACH FF",[]]]],["Return (if no decision by 12:00 CST)","Return (if no decision by 12:00 CST)",[["Debit ACH FF Only (most common)","Debit ACH FF Only (most common)",[]],["Credit ACH FF Only (rare)","Credit ACH FF Only (rare)",[]],["Credit & Debit ACH FF","Credit & Debit ACH FF",[]]]]],"initValues":null,"disable_children":false,"include_blank":"...","selected":null,"pl_value_id":"42000354151","subcategory_id":"helpdesk_ticket_custom_field_cf_default_decision363114_870937_42000354151"}); //]]> </script> </div>
<label class=" control-label cf_ts_customer_email_address_870937-label " for="helpdesk_ticket_cf_ts_customer_email_address_870937">Customer Notification Email Address (if applicable)</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_ts_customer_email_address_870937]" id="helpdesk_ticket_custom_field_cf_ts_customer_email_address_870937" /> </div>
<label class=" control-label cf_treas_pric_services746400_870937-label " for="helpdesk_ticket_cf_treas_pric_services746400_870937">Services</label> <div class="controls "> <select class=" dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_treas_pric_services746400_870937]" id="helpdesk_ticket_custom_field_cf_treas_pric_services746400_870937"><option value="">...</option> <option data-id="42000333414" value="New TM Setup">New TM Setup</option> <option data-id="42000333415" value="Fee Inquiry/Research">Fee Inquiry/Research</option> <option data-id="42000333416" value="Maintenance Request">Maintenance Request</option></select> </div>
<label class=" required control-label cf_business_name832087_870937-label " for="helpdesk_ticket_cf_business_name832087_870937">Treas Pricing_Business Name</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_business_name832087_870937]" id="helpdesk_ticket_custom_field_cf_business_name832087_870937" /> </div>
<label class=" required control-label cf_tp_account_number_870937-label " for="helpdesk_ticket_cf_tp_account_number_870937">Treas Pricing_Account Number</label> <div class="controls "> <input class=" required number section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_tp_account_number_870937]" id="helpdesk_ticket_custom_field_cf_tp_account_number_870937" /> </div>
<label class=" control-label cf_tm_representative_name_870937-label " for="helpdesk_ticket_cf_tm_representative_name_870937">TM Representative Name</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_tm_representative_name_870937]" id="helpdesk_ticket_custom_field_cf_tm_representative_name_870937" /> </div>
<label class=" control-label cf_tm_resp_code_870937-label " for="helpdesk_ticket_cf_tm_resp_code_870937">TM Resp Code</label> <div class="controls "> <input class=" number section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_tm_resp_code_870937]" id="helpdesk_ticket_custom_field_cf_tm_resp_code_870937" /> </div>
<label class=" required control-label cf_ts_request_types_870937-label " for="helpdesk_ticket_cf_ts_request_types_870937">Support Needed</label> <div class="controls "> <select class=" required dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_ts_request_types_870937]" id="helpdesk_ticket_custom_field_cf_ts_request_types_870937"><option value="">...</option> <option data-id="42000330502" value="ACH FF/Check Positive Pay Support">ACH FF/Check Positive Pay Support</option> <option data-id="42000330501" value="ACH Origination Support">ACH Origination Support</option> <option data-id="42000317085" value="Activation Key/Unlock Token">Activation Key/Unlock Token</option> <option data-id="42000330878" value="Analysis Fee Adjustment">Analysis Fee Adjustment</option> <option data-id="42000354073" value="Bill Pay">Bill Pay</option> <option data-id="42000334435" value="Document Prep Request from TM">Document Prep Request from TM</option> <option data-id="42000317084" value="General Support">General Support</option> <option data-id="42000341497" value="Mobile App/Mobile Deposit">Mobile App/Mobile Deposit</option> <option data-id="42000317083" value="Onboarding">Onboarding</option> <option data-id="42000341498" value="QuickBooks Assistance">QuickBooks Assistance</option> <option data-id="42000330503" value="Remote Deposit Support">Remote Deposit Support</option> <option data-id="42000333419" value="Secure Browser Assistance">Secure Browser Assistance</option> <option data-id="42000333558" value="Secure Browser Update Assistance">Secure Browser Update Assistance</option> <option data-id="42000338970" value="Statement/Research Request">Statement/Research Request</option> <option data-id="42000328560" value="Temporary Limit Increase (ACH/Wire)">Temporary Limit Increase (ACH/Wire)</option> <option data-id="42000338817" value="TM Setup">TM Setup</option> <option data-id="42000330504" value="Wire Transfer Support">Wire Transfer Support</option> <option data-id="42000347477" value="Blackhawk - ACH (file, templates, payees, etc.)">Blackhawk - ACH (file, templates, payees, etc.)</option> <option data-id="42000347478" value="Blackhawk - non-TM Request">Blackhawk - non-TM Request</option> <option data-id="42000347479" value="Blackhawk - Online Banking Installation/Navigation">Blackhawk - Online Banking Installation/Navigation</option> <option data-id="42000347638" value="Blackhawk - Positive Pay">Blackhawk - Positive Pay</option> <option data-id="42000347480" value="Blackhawk - Remote Deposit">Blackhawk - Remote Deposit</option> <option data-id="42000347481" value="Blackhawk - Research Request">Blackhawk - Research Request</option> <option data-id="42000347482" value="Blackhawk - Wires">Blackhawk - Wires</option></select> </div>
<label class=" required control-label cf_tscustomer_name_870937-label " for="helpdesk_ticket_cf_tscustomer_name_870937">Customer Name</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_tscustomer_name_870937]" id="helpdesk_ticket_custom_field_cf_tscustomer_name_870937" /> </div>
<label class=" required control-label cf_ts_account_number812331_870937-label " for="helpdesk_ticket_cf_ts_account_number812331_870937">Account Number(s)</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_ts_account_number812331_870937]" id="helpdesk_ticket_custom_field_cf_ts_account_number812331_870937" /> </div>
<label class=" control-label cf_request_type437874_870937-label " for="helpdesk_ticket_cf_request_type437874_870937">Product/Request</label> <div class="controls nested_field "> <select class=" nested_field section_field" id="helpdesk_ticket_custom_field_cf_request_type437874_870937_42000339418" name="helpdesk_ticket[custom_field][cf_request_type437874_870937]"><option value="">...</option> <option value="Access Inquiry">Access Inquiry</option> <option value="Dispute">Dispute</option> <option value="General Inquiry">General Inquiry</option> <option value="Limits">Limits</option> <option value="Payment Research">Payment Research</option></select><div class="level_2"><label class="">Services</label><select class=" nested_field section_field" id="helpdesk_ticket_custom_field_cf_services108880_870937_42000339418" name="helpdesk_ticket[custom_field][cf_services108880_870937]"><option value="">...</option> </select></div><script> //<![CDATA[ jQuery('#helpdesk_ticket_custom_field_cf_request_type437874_870937_42000339418').nested_select_tag({"data_tree":[["Access Inquiry","Access Inquiry",[["Token","Token",[]],["Bill Pay","Bill Pay",[]],["Suspension","Suspension",[]],["Unlock","Unlock",[]]]],["Dispute","Dispute",[["Inbound","Inbound",[]],["Outbound","Outbound",[]],["Credit Refusals","Credit Refusals",[]]]],["General Inquiry","General Inquiry",[]],["Limits","Limits",[["Temporary","Temporary",[]],["Permanent","Permanent",[]]]],["Payment Research","Payment Research",[["Recipient Token ID","Recipient Token ID",[]],["Recipient Name","Recipient Name",[]],["Transaction Amount","Transaction Amount",[]],["Transaction Date","Transaction Date",[]]]]],"initValues":null,"disable_children":false,"include_blank":"...","selected":null,"pl_value_id":"42000339418","subcategory_id":"helpdesk_ticket_custom_field_cf_services108880_870937_42000339418"}); //]]> </script> </div>
<div class="controls"> <label class="checkbox "> <input name="helpdesk_ticket[custom_field][cf_access_inquiry_870937]" type="hidden" value="0" /><input class=" checkbox section_field" id="helpdesk_ticket_custom_field_cf_access_inquiry_870937_42000339418" type="checkbox" value="1" name="helpdesk_ticket[custom_field][cf_access_inquiry_870937]" /> For Suspension and Unlock -Complete the following- </label> </div>
<label class=" control-label cf_does_the_customer_personally_know_who_they_are_sending_funds_to_870937-label " for="helpdesk_ticket_cf_does_the_customer_personally_know_who_they_are_sending_funds_to_870937">Does the customer PERSONALLY know who they are sending funds to?</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_does_the_customer_personally_know_who_they_are_sending_funds_to_870937]" id="helpdesk_ticket_custom_field_cf_does_the_customer_personally_know_who_they_are_sending_funds_to_870937" /> </div>
<label class=" control-label cf_can_the_customer_provide_the_first_and_last_name_of_the_recipientcontact_870937-label " for="helpdesk_ticket_cf_can_the_customer_provide_the_first_and_last_name_of_the_recipientcontact_870937">Can the customer provide the first and last name of the recipient/contact?</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_can_the_customer_provide_the_first_and_last_name_of_the_recipientcontact_870937]" id="helpdesk_ticket_custom_field_cf_can_the_customer_provide_the_first_and_last_name_of_the_recipientcontact_870937" /> </div>
<label class=" control-label cf_is_this_transfer_for_the_purchase_of_goods_or_services_870937-label " for="helpdesk_ticket_cf_is_this_transfer_for_the_purchase_of_goods_or_services_870937">Is this transfer for the purchase of goods or services?</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_is_this_transfer_for_the_purchase_of_goods_or_services_870937]" id="helpdesk_ticket_custom_field_cf_is_this_transfer_for_the_purchase_of_goods_or_services_870937" /> </div>
<label class=" required control-label cf_customer_verification_870937-label " for="helpdesk_ticket_cf_customer_verification_870937">Customer Verification</label> <div class="controls "> <select class=" required dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_customer_verification_870937]" id="helpdesk_ticket_custom_field_cf_customer_verification_870937"><option value="">...</option> <option data-id="42000340360" value="FIS">FIS</option> <option data-id="42000340361" value="Security Questions">Security Questions</option> <option data-id="42000340362" value="Driver's License">Driver's License</option></select> </div>
<label class=" control-label cf_sender_token_id_870937-label " for="helpdesk_ticket_cf_sender_token_id_870937">Sender Token ID</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_sender_token_id_870937]" id="helpdesk_ticket_custom_field_cf_sender_token_id_870937" /> </div>
<label class=" control-label cf_intended_recipient_name_870937-label " for="helpdesk_ticket_cf_intended_recipient_name_870937">Intended Recipient Name</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_intended_recipient_name_870937]" id="helpdesk_ticket_custom_field_cf_intended_recipient_name_870937" /> </div>
<label class=" required control-label cf_account_number529801_870937-label " for="helpdesk_ticket_cf_account_number529801_870937">Account Number</label> <div class="controls "> <input class=" required number section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_account_number529801_870937]" id="helpdesk_ticket_custom_field_cf_account_number529801_870937" /> </div>
<label class=" required control-label cf_customerbusiness_name_870937-label " for="helpdesk_ticket_cf_customerbusiness_name_870937">Customer Name</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_customerbusiness_name_870937]" id="helpdesk_ticket_custom_field_cf_customerbusiness_name_870937" /> </div>
<label class=" control-label cf_transaction_amount_870937-label " for="helpdesk_ticket_cf_transaction_amount_870937">Transaction Amount</label> <div class="controls "> <input class=" number section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_transaction_amount_870937]" id="helpdesk_ticket_custom_field_cf_transaction_amount_870937" /> </div>
<label class=" control-label cf_date_of_transactions_870937-label " for="helpdesk_ticket_cf_date_of_transactions_870937">Date of Transaction(s)</label> <div class="controls support-date-field "> <input type="text" name="helpdesk_ticket[custom_field][cf_date_of_transactions_870937]" id="helpdesk_ticket_custom_field_cf_date_of_transactions_870937" class=" date section_field datepicker_popover" readonly="readonly" data-show-image="true" data-date-format="d M, yy" placeholder="" /> </div>
Your Email
Description. (Please include all pertinent information)
+
Attach a file
Cancel
Help Desk Software
by Freshdesk