{% extends "modules/marketplace/templates/marketplace/public_base.html" %}
{% block public_content %}
<section class="mx-auto max-w-4xl px-4 py-12 sm:px-6 lg:px-8">
  <div class="rounded-3xl border border-slate-200 bg-white p-6 shadow-soft sm:p-8">
    <h1 class="text-3xl font-bold">Request Professional Service</h1>
    <p class="mt-2 text-sm text-slate-600">Submit your requirement. The marketplace team will review and route it to the right audit firm or consultant.</p>
    <form method="post" class="mt-6 grid gap-4 md:grid-cols-2">
      <input type="hidden" name="csrf_token" value="{{ csrf_token }}">
      <label class="text-sm font-medium">Your Name<input name="lead_name" required class="mt-1 w-full rounded-xl border border-slate-300 px-3 py-2"></label>
      <label class="text-sm font-medium">Business Name<input name="business_name" class="mt-1 w-full rounded-xl border border-slate-300 px-3 py-2"></label>
      <label class="text-sm font-medium">Email<input name="email" type="email" class="mt-1 w-full rounded-xl border border-slate-300 px-3 py-2"></label>
      <label class="text-sm font-medium">Mobile<input name="mobile" required class="mt-1 w-full rounded-xl border border-slate-300 px-3 py-2"></label>
      <label class="text-sm font-medium">City<input name="city" class="mt-1 w-full rounded-xl border border-slate-300 px-3 py-2"></label>
      <label class="text-sm font-medium">State<input name="state" class="mt-1 w-full rounded-xl border border-slate-300 px-3 py-2"></label>
      <label class="text-sm font-medium">Category<select name="service_category" class="mt-1 w-full rounded-xl border border-slate-300 px-3 py-2"><option value="">Select</option>{% for c in service_categories %}<option value="{{ c }}">{{ c }}</option>{% endfor %}</select></label>
      <label class="text-sm font-medium">Service Required<input name="service_requested" required placeholder="GST notice reply, ITR filing, audit..." class="mt-1 w-full rounded-xl border border-slate-300 px-3 py-2"></label>
      <label class="text-sm font-medium md:col-span-2">Message<textarea name="message" rows="4" class="mt-1 w-full rounded-xl border border-slate-300 px-3 py-2"></textarea></label>
      <div class="md:col-span-2"><button class="rounded-xl bg-brand-600 px-5 py-3 text-sm font-bold text-white shadow-soft">Submit Request</button></div>
    </form>
  </div>
</section>
{% endblock %}