50 lines
3.4 KiB
PHP
50 lines
3.4 KiB
PHP
<?php include 'header.php'; ?>
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<main style="background: #0b0e11; color: white; min-height: 100vh; padding: 100px 5%;">
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<div style="max-width: 700px; margin: 0 auto; background: #161a1e; padding: 50px; border-radius: 32px; border: 1px solid #2b3139;">
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<h1 style="font-size: 2.2rem; margin-bottom: 10px;">Submit a Request</h1>
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<p style="color: var(--text-muted); margin-bottom: 40px;">Please provide the details of your request and we will get back to you as soon as possible.</p>
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<form action="#" method="POST">
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<div style="margin-bottom: 25px;">
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<label style="display: block; margin-bottom: 10px; color: #848e9c; font-size: 0.9rem;">Email Address</label>
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<input type="email" required placeholder="your@email.com" style="width: 100%; padding: 15px; background: #0b0e11; border: 1px solid #2b3139; color: white; border-radius: 12px; outline: none; box-sizing: border-box;">
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</div>
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<div style="margin-bottom: 25px;">
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<label style="display: block; margin-bottom: 10px; color: #848e9c; font-size: 0.9rem;">Issue Category</label>
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<select style="width: 100%; padding: 15px; background: #0b0e11; border: 1px solid #2b3139; color: white; border-radius: 12px; outline: none; box-sizing: border-box;">
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<option>Account Security</option>
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<option>Deposit/Withdrawal Issue</option>
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<option>Trading Error</option>
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<option>Identity Verification (KYC)</option>
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<option>Bug Report</option>
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<option>Other</option>
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</select>
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</div>
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<div style="margin-bottom: 25px;">
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<label style="display: block; margin-bottom: 10px; color: #848e9c; font-size: 0.9rem;">Subject</label>
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<input type="text" required placeholder="Brief summary of your issue" style="width: 100%; padding: 15px; background: #0b0e11; border: 1px solid #2b3139; color: white; border-radius: 12px; outline: none; box-sizing: border-box;">
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</div>
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<div style="margin-bottom: 25px;">
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<label style="display: block; margin-bottom: 10px; color: #848e9c; font-size: 0.9rem;">Description</label>
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<textarea rows="6" required placeholder="Please provide as much detail as possible..." style="width: 100%; padding: 15px; background: #0b0e11; border: 1px solid #2b3139; color: white; border-radius: 12px; outline: none; box-sizing: border-box; resize: none;"></textarea>
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</div>
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<div style="margin-bottom: 30px;">
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<label style="display: block; margin-bottom: 10px; color: #848e9c; font-size: 0.9rem;">Attachments (Optional)</label>
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<div style="border: 2px dashed #2b3139; padding: 30px; text-align: center; border-radius: 12px; cursor: pointer;" onmouseover="this.style.borderColor='var(--primary-color)'" onmouseout="this.style.borderColor='#2b3139'">
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<i class="fas fa-cloud-upload-alt" style="font-size: 2rem; color: #848e9c; margin-bottom: 10px;"></i>
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<p style="color: #848e9c; margin: 0; font-size: 0.9rem;">Click or drag files to upload</p>
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</div>
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</div>
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<button type="submit" class="btn-primary" style="width: 100%; padding: 18px; border-radius: 12px; font-weight: bold; font-size: 1.1rem;">Submit Ticket</button>
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</form>
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</div>
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</main>
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<?php include 'footer.php'; ?>
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