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HTML
<STYLE TYPE='text/css'>
#loading-en
    {
    display:none;
    left: 16%;
    position: absolute;
    top: 30%;
    width: 300%;
    z-index: 1000;
    }
  
    #loadingcontent-en
    {
    height: 60%;
    left: 50%;
    top: 50%;
    width: 60%;
    }
  
    #loadingspinner-en
    {
    top: 50%;
    width: 30%;
 }
    #captcha{margin-bottom:0;padding-bottom:0}#captcha .captcha-container{clear:none;margin:5px 0 0 0;min-height:0;overflow:hidden;padding:0} #captcha .captcha-container .captcha-image{float:left}#captcha .captcha-container .captcha-trigger{float:left} #captcha .captcha-container .captcha-trigger .content{margin:0;overflow:hidden;text-align:left;text-indent:-999em;width:0} #captcha .captcha-container .icon-reload{background-image:url("data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAABAAAAAQBAMAAADt3eJSAAAAMFBMVEX///9wcHBwcHBwcHBwcHBwcHBwcHBwcHBwcHBwcHBwcHBwcHBwcHBwcHBwcHAAAAAM3lI2AAAADnRSTlMAESIzRFVmiJmqu8zd7qUOxRYAAAB3SURBVHjaY2axe9y7PGDtDyZGg+zYTvZDDExMpvWpnZb/GZgYPb5tYPhpDxRhnMvAwPCBgYmZITMAyGJgYTyz5wMDMmAEk+7GKUwQbooAM5hxR14HKKLAwMAc/x/I2CHA4PVzH1AqqECgq+wzkLEj3GtqPyfcHAB0GR2Spl8/YwAAAABJRU5ErkJggg==")} </STYLE>
<script src='http://ajax.googleapis.com/ajax/libs/jquery/1.7.1/jquery.min.js'></script> 
<div id="loading-en">
<div id="loadingcontent-en">
<span id='loadingspinner-en' class='aui-icon aui-icon-wait'>Loading...</span>
</div>
</div>

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

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

<img src="https://www.iconexperience.com/_img/v_collection_png/128x128/shadow/bug_red.png>
<input type='hidden' name='form-index' id='form-index-en' value='117'/>
<div>
<select id='feedback-issue-type-en' data-placeholder="Тип обращения..." name='feedback-issue-type'>
<option value='10' selected >Question</option>
<option value='27'>Bug</option>
<option value='4'>Idea</option>
    </select>
<script>
AJS.$("#feedback-issue-type-en").auiSelect2();
</script>
</div>
 

<br> <div><input class="text long-field-en" type='text' id='feedback-summary-en' name='feedback-summary' class='feedback-summary' placeholder='The short summary' 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='en'/></div>

<div><TEXTAREA class="textarea long-field" id='feedback-body-en' name='feedback-body' ROWS='5' placeholder='You can put more details here...'></TEXTAREA>
</div>

<br>
<div>
<select id="feedback-fix-version-en" multiple data-placeholder="Software..." name='feedback-fix-version'>
<option value='21821'selected >CRM for JIRA</option>
<option value='21822'>Calendar for JIRA</option>
<option value='21920'>HelpDesk for JIRA</option>
<option value='19729'>Feedback for JIRA</option>
<option value='21820'>Werewolf for JIRA</option>
    </select>
<script>
AJS.$("#feedback-fix-version-en").auiSelect2();
</script>
 
</div>
<br>
<div>
<input class="text" type='text' id='feedback-email-en' name='feedback-email' placeholder='Your E-mail' size='38' value=''/>
</div>
<br>
<div>
<input class="text" type='file' id='feedback-attachment-en' name='feedback-attachment' size='38' />
</div>
<br>
 
<div align="left"> 
<input class="aui-button aui-button-primary" type='button' value=' Send ' onclick='addFeedbackEn()'/>
</div>
</form>
</div>
 
<div id="feedback-back-en" class="aui" style="display: none">
  <input type="button" class="aui-button" onclick="jQuery('#feedback-main-div-en').show();jQuery('#feedback-response-en').hide();jQuery('#feedback-back-en').hide();    jQuery('.captcha-reload').click();" value="Back"/>
</div>
<iframe id='feedback-response-en' name='feedback-response-en' frameborder='no' style='display: none;' width='500' height='250'></iframe>
 
<script type='text/javascript'>
 
JIRACaptcha = {
    setup: function () {
        jQuery("#captcha").delegate("span.captcha-reload", "click", function (e) {
            JIRACaptcha.refresh();
            e.preventDefault();
        });
    }, refresh: function () {
        var img = jQuery(".captcha-image", "#captcha .captcha-container"), src = img.attr("src");
        if (src.indexOf("__r") >= 0) {
            src = src.replace(/__r=([^&]+)/, "__r=" + Math.random());
        } else {
            src = src.indexOf('?') >= 0 ? (src + "&__r=" + Math.random()) : (src + "?__r=" + Math.random());
        }
        img.attr("src", src);
        jQuery("#captcha .captcha-response").focus();
    }
};

 
jQuery(window).load(function()
{
jQuery(JIRACaptcha.setup);
   jQuery('#feedback-main-div-en').show();
   jQuery('#feedback-new-issue-div-en').hide();
   jQuery('#feedback-response-en').hide();
   jQuery('#feedback-new-issue-button-en').click(function ()
   {
    jQuery('.captcha-reload').click();
    jQuery('#feedback-main-div-en').show();
    jQuery('#feedback-new-issue-div-en').hide();
    jQuery('#feedback-response-en').hide();
   });
});

function addFeedbackEn() {
if ( document.getElementById('feedback-attachment-en').files.length > 0 )
{
var attachSize = document.getElementById('feedback-attachment-en').files[0].size; 
if ( attachSize > 1000000 * 10 )
{ var message = '<div>Attachment size exceeds the allowable limit</div>'; jQuery('#feedback-error-en').html(message); return false; }}
   var summary = jQuery('#feedback-summary-en').val();
   var email = jQuery('#feedback-email-en').val();
   if (summary == '' || email == '')
   {
    var message = '';
    if (summary == '')
    {
     message = message + '<div>Enter the Summary please</div>';
    }
    if (email == '')
    {
     message = message + '<div>Enter the E-mail please</div>';
    }
    jQuery('#feedback-error-en').html(message);
    return false;
}

   jQuery('#feedback-error-en').html('');
   jQuery('#feedback-main-div-en').hide();
   jQuery('#loading-en').fadeIn();
   jQuery('#feedback-response-en').show();
   jQuery('#feedback-back-en').show();
   jQuery('#feedback-form-en').submit();
   jQuery('#feedback-response-en').on("load", function() {
   jQuery('#feedback-new-issue-div-en').show();
   jQuery('#loading-en').fadeOut();
}); 
   return false;
}
</script>