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<STYLE TYPE='text/css'>
#loading{
display:none;
vertical-align:baseline;
position:fixed;
left:0;
top:0;
width:100%;
height:100%;
z-index:1000;}
#loadingcontent{
position:fixed;
left:20%;
top:35%;
width:50%;
height:50%;}
#loadingspinner{
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width: 10%;
text-align: center;
font-size:larger;} 
textarea { width: 100%; margin: 0; padding: 0; border-width: 1; }
.feedback-summary { width: 100%; margin: 0; padding: 0; border-width: 1; }
BODY, input, select, table {
font-size: 12px;font-family: Arial,Helvetica,FreeSans,'sans - serif';}
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<script src='http://ajax.googleapis.com/ajax/libs/jquery/1.7.1/jquery.min.js'></script> 
<div id="loading">
<div id="loadingcontent">
<img id="loadingspinner" src="http://www.teamlead.ru/download/attachments/25591816/loader.gif?api=v2" alt="Loading"/>
</div>
</div>

<div id='feedback-main-div' style='font-size: 14px; font-family: Arial,Helvetica,FreeSans,sans-serif'>
<div id='feedback-error'></div>

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

<input type='hidden' name='form-index' id='form-index' value='1'/>

<div><select<div>
<select class="select" id='feedback-issue-type' name='feedback-issue-type'>
<option value='25' selected >Покупка продуктов или услуг</option>
<option value='10'>Техническая консультация</option>
<option value='27'>Ошибка в работе приложения</option>
<option value='1'>Сбой всей системы</option>
<option value='4'>Улучшение</option>
</select>
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<br> <div><input class="text long-field" type='text' id='feedback-summary' name='feedback-summary' class='feedback-summary' placeholder='Тема обращения' value=''/></div>
<br> <div style='display:none;'><input type='text' id='feedback-language' name='feedback-language' class='feedback-language' placeholder='Выберите язык (en/ru)' value='ru'/></div>

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

<br>
<div>
<select id="feedback-fix-version" multiple data-placeholder="Выберите продукты..." name='feedback-fix-version'>
<option value='13020'>JIRA</option>
<option value='13021'>Confluence</option>
<option value='21821'>CRM for JIRA</option>
<option value='22120'>JIRA Service Desk</option>
<option value='13027'>JIRA Agile</option>
<option value='21228'>Stash</option>
<option value='13025'>Bamboo</option>
<option value='13024'>Crucible</option>
<option value='13023'>FishEye</option>
<option value='13022'>Crowd</option>
<option value='16920'>Bitbucket</option>
<option value='19729'>Feedback for JIRA</option>
<option value='21820'>Werewolf forJIRA</option>
<option value='21822'>Calendar for JIRA</option>
<option value='23320'>Tempo Timesheet</option>
<option value='13029'>Team Calendars for Confluence</option>
<option value='13028'>Capture for JIRA</option>
<option value='19723'>Локализация JIRA</option>
<option value='19724'>Локализация Confluence</option>
<option value='19726'>Локализация Agile</option>
<option value='19727'>Локализация Tempo</option>
<option value='21920'>Локализация JIRA Service Desk</option>
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<script>
AJS.$("#feedback-fix-version").auiSelect2();
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</div>
<br>
<div>
<input class="text" type='text' id='feedback-email' name='feedback-email' placeholder='E-mail для ответа' size='38' value=''/>
</div>
<br>
<div>
<input class="text" type='file' id='feedback-attachment' name='feedback-attachment' size='38' />
</div>
<br>
<div align="left"> 
<input class="aui-button aui-button-primary" type='button' value=' Задать вопрос ' onclick='addFeedback()'/>
</div>
</form>
</div>
 
<iframe id='feedback-response' name='feedback-response' frameborder='no' style='display: none' width='450' height='200'></iframe>
 
<div id='feedback-new-issue-div'><input class="aui-button aui-button-primary" type='button' id='feedback-new-issue-button' value='Создать еще запрос'></div>
 
<script type='text/javascript'>
jQuery(window).load(function()
{
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});

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