<div id="questionsModal" class="modal fade new-popup js-delivery-feedback-form"> 
    <div class="modal-dialog"> 
        <div class="modal-content"> 
            <button class="close" data-dismiss="modal"></button> 
            <div class="font-size-1250 sf-bold-font mb-3">Опишите ваше предложение, при необходимости мы обязательно 
                свяжемся с вами 
            </div> 
            <div class="delivery-teaser-row mb-3 w-100"> 
                <div class="col-6"> 
                    <div class="mr-3"> 
                        <div class="px-2 border border-radius-0375 text-left"> 
                            <input name="deliveryFeedbackName" type="text" 
                                   class="form-control p-0 border-none" 
                                   value="{{ app.user ? app.user.getFirstName() }}"> 
                            <small class="text-muted d-block">Ваше имя</small> 
                        </div> 
                    </div> 
                </div> 
                <div class="col-6"> 
                    <div class="px-2 border border-radius-0375 text-left"> 
                        <input name="deliveryFeedbackEmail" type="email" class="form-control p-0 border-none" 
                               value="{{ app.user ? app.user.getEmail() }}"> 
                        <small class="text-muted d-block">E-mail</small> 
                    </div> 
                </div> 
            </div> 
            <div class="delivery-teaser-row"> 
                <div class="w-100 px-2 border border-radius-0375 text-left"> 
                        <textarea name="deliveryFeedback" class="form-control p-0 border-none w-100" 
                                  placeholder="Напишите ваше предложение"></textarea> 
                </div> 
                <div id="questions_recaptcha" class="g-recaptcha" data-sitekey="6LdyqnMmAAAAAAE9yAUOVmdRPJhAq02-VwVBPR5i" style="margin: 11px auto;"></div> 
                <div class="w-100"> 
                    <label class="questions-validate d-none sf-display-font font-size-0750 color-red font-size-0750 text-red pt-2 pl-2"></label> 
                    <button/> 
                    <button class="button mt-3 text-uppercase" type="button" 
                            data-url="/delivery/feedback/auth" id="deliveryFeedbackSubmit">Отправить 
                    </button> 
                </div> 
            </div> 
        </div> 
    </div> 
</div>