91 lines
4.4 KiB
PHP
91 lines
4.4 KiB
PHP
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<div class="bg-white max-w-lg w-full rounded-[8px]">
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<div class="p-[24px]">
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<h2 class="text-[24px] font-bold text-gray-900 mb-[16px]">
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Заказать клубную карту
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</h2>
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<form class="space-y-[16px]">
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<div>
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<label for="name" class="block text-[14px] font-medium text-gray-700 mb-[8px]">
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Имя *
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</label>
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<input type="text"
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id="name"
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name="name"
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required
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class="w-full px-[12px] py-[8px] border border-gray-300 rounded-[6px] focus:outline-none focus:ring-2 focus:ring-blue-500">
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</div>
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<div>
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<label for="email" class="block text-[14px] font-medium text-gray-700 mb-[8px]">
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Email *
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</label>
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<input type="email"
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id="email"
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name="email"
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required
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class="w-full px-[12px] py-[8px] border border-gray-300 rounded-[6px] focus:outline-none focus:ring-2 focus:ring-blue-500">
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</div>
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<div>
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<label for="phone" class="block text-[14px] font-medium text-gray-700 mb-[8px]">
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Телефон *
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</label>
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<input type="tel"
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id="phone"
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name="phone"
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required
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class="w-full px-[12px] py-[8px] border border-gray-300 rounded-[6px] focus:outline-none focus:ring-2 focus:ring-blue-500">
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</div>
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<div>
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<label for="card-type" class="block text-[14px] font-medium text-gray-700 mb-[8px]">
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Тип карты
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</label>
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<select id="card-type"
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name="card-type"
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class="w-full px-[12px] py-[8px] border border-gray-300 rounded-[6px] focus:outline-none focus:ring-2 focus:ring-blue-500">
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<option value="">Выберите тип карты</option>
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<option value="basic">Базовая</option>
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<option value="premium">Премиум</option>
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<option value="vip">VIP</option>
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</select>
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</div>
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<div>
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<label for="message" class="block text-[14px] font-medium text-gray-700 mb-[8px]">
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Комментарий
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</label>
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<textarea id="message"
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name="message"
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rows="3"
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class="w-full px-[12px] py-[8px] border border-gray-300 rounded-[6px] focus:outline-none focus:ring-2 focus:ring-blue-500 resize-none"></textarea>
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</div>
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<div class="flex items-center">
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<input type="checkbox"
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id="agreement"
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name="agreement"
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required
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class="mr-[8px] w-[16px] h-[16px] text-blue-600 border-gray-300 rounded focus:ring-blue-500">
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<label for="agreement" class="text-[14px] text-gray-700">
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Я согласен с обработкой персональных данных *
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</label>
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</div>
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</form>
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<div class="flex justify-end gap-[12px] mt-[24px]">
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<button data-modal-close
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type="button"
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class="px-[24px] py-[12px] bg-gray-500 text-white rounded-[6px] hover:bg-gray-600 transition-colors duration-[300ms]">
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Отмена
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</button>
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<button type="submit"
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class="px-[24px] py-[12px] bg-blue-500 text-white rounded-[6px] hover:bg-blue-600 transition-colors duration-[300ms]">
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Отправить заявку
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</button>
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</div>
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</div>
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</div>
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