ZenDesk Widget to pull ID's from Facebook/MySpace/Google+ or internal ID

We use Zendesk as our CRM to help customers with our products across Facebook, MySpace, Google+ or our internal network. We would like a widget that pulls the UID from these sources and assigns them to text field and selects the correct platform from a drop down field. Please sign-up at [login to view URL] and then go to the new ticket page here: [login to view URL] to see fields and desired UI. The internal ID is gathered using {{requester.external_id}} This should be a widget that lives on ZenDesk. We will also require a stand alone page that does the above (minus the internal ID) that can migrated anywhere.