Phraseanet/templates/web/Mustache/Prod/Feedback-SendForm.Mustache.html

<form>
    <div class="Feedback" style="display:none;">
        <label for="PushSendFormDuration">{{ language.FeedBackDuration }}</label>
        <select id="PushSendFormDuration" name="duration">
            <option value="20">20</option>
            <option value="15">15</option>
            <option value="10">10</option>
            <option value="5">5</option>
            <option value="3">3</option>
            <option value="2">2</option>
            <option value="1">1</option>
        </select>
    </div>
    <div>
        <label for="PushSendFormRecept">{{ language.FeedBackName }}</label>
        <input id="PushSendFormName" type="text" name="name"/>
    </div>
    <div>
        <label for="PushSendFormMessage">{{ language.FeedBackMessage }}</label>
        <textarea id="PushSendFormMessage" name="message"></textarea>
    </div>
    <div>
        <label for="PushSendFormRecept" class="checkbox">
            <input id="PushSendFormRecept" type="checkbox" name="recept" value="1"/>
            {{ language.Recept }}
        </label>
    </div>
</form>