Prime-Risk-Advisory/contact-form.html at main · CoreJavaPulse/Prime-Risk-Advisory · GitHub

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<!-- ✅ EMBEDDED SECURE CONTACT MODAL (VISUALLY IDENTICAL) -->
<div class="contact-modal" id="contactModal" role="dialog" aria-modal="true"
    aria-labelledby="contactModalTitle" aria-describedby="contactModalDesc">
    <div class="modal-overlay" id="closeModal"></div>
    <div class="modal-content secure-modal">
        <button class="modal-close" id="modalCloseBtn" aria-label="Close">×</button>
        <div class="secure-badge">Secure & Confidential Channel</div>
        <h2 id="contactModalTitle">Request a Confidential Discussion</h2>
        <p class="modal-note secure-note" id="contactModalDesc">
            This secure channel is intended for sensitive inquiries. Information is accessible only to authorized
            personnel. Please do not include passwords, OTPs, or full account numbers.
        </p>

        <!-- ✅ PERFECT FORM -->
        <form class="contact-form"
            action="https://script.google.com/macros/s/AKfycbyf_-rOi88GFxIeMnoUQJcVCsEUdtvs88hKjhKgi4oGYyfjIcn9o9bcIDZjInsORMRG/exec"
            method="POST" novalidate>

            <input type="hidden" name="_csrf" value="generate-unique-token">
            <input type="hidden" name="source" value="Secure Website Contact">
            <input type="hidden" name="confidentiality" value="Privileged & Confidential">
            <input type="hidden" name="hp_email" autocomplete="off">

            <label for="name">Full Name *
                <input id="name" type="text" name="name" required autocomplete="name" placeholder="Full Name">
            </label>
            <label for="email">Email Address *
                <input id="email" type="email" name="email" required autocomplete="email"
                    placeholder="your.email@example.com">
            </label>
            <label for="phone">Phone
                <input id="phone" type="tel" name="phone" placeholder="XXX XXX-XXXX" autocomplete="tel">
            </label>
            <label for="org">Organization / Institution
                <input id="org" type="text" name="organization" placeholder="Institution name"
                    autocomplete="organization">
            </label>
            <label for="service">Service Type *
                <select id="service" name="service_type" required>
                    <option value="">Select a service</option>
                    <option value="credit integrity audit">Credit Integrity Review</option>
                    <option value="staff accountability review">Staff Accountability Assessment</option>
                    <option value="vendor surveillance">Third-Party Vendor Review</option>
                    <option value="ews monitoring">Early Warning Signal Monitoring</option>
                    <option value="other">Other / Not Sure</option>
                </select>
            </label>

            <label for="message">Nature of Inquiry
                <textarea id="message" name="message" rows="4"
                    placeholder="High-level description only. Do not include credentials or account numbers."></textarea>
            </label>

            <div class="secure-footer">
                <span>🔒 Encrypted transmission</span>
                <span>🛡️ Restricted professional access</span>
            </div>

            <p id="formFeedback" class="small-note" style="display:none;" role="alert" aria-live="polite"></p>
            <button type="submit" class="form-submit secure-submit">
                <span class="btn-text">Submit Secure Request</span>
                <span class="btn-spinner" aria-hidden="true"></span>
            </button>

            <p class="small-note">Engagements are subject to independence and conflict-of-interest checks.</p>
        </form>

        <!-- SUCCESS STATE -->
        <div class="success-state" hidden role="status" aria-live="polite">
            <div class="success-check">✓</div>
            <h3>Request Submitted</h3>
            <p>Your confidential request has been received. Our team will review and respond appropriately.</p>
            <button type="button" class="success-close">Close</button>
        </div>
    </div>
</div>