<form action="<your-form-action>" method="post">
<label>Your Email: <input type="email" name="Email" required /></label>
<label>Describe your problem: <textarea name="Problem" placeholder="As much detail as possible" required ></textarea></label>
<input type="hidden" name="Status" value="new" />
<input type="hidden" name="Created" value="x-sheetmonkey-current-date-time" />
<input type="submit" value="Submit Ticket" />