File: //var/www/quadcode/frontend/src/html/lp/free-brokerage/forms.html
<section class="forms" id="forms">
<div class="container">
<!-- Сообщения -->
<div class="form-message form-success" style="display: none">
<div class="form-message__icon">
<img src="../../../assets/resource/lp/Group%20666.png" alt="" />
</div>
<div class="form-message__inner">
<div
class="form-message__title titleL"
data-lang="lng-form-success-title"
>
Your message has been successfully sent
</div>
<div
class="form-message__text defaultBase"
data-lang="lng-form-success-text"
>
Thank you for your interest! Our team will contact you shortly to
discuss the details.
</div>
<div class="form-message__actions">
<a
href="#"
class="button CTABase"
onclick="window.location.reload(); return false;"
data-lang="lng-ok"
>
OK
</a>
</div>
</div>
</div>
<div class="form-message form-error" style="display: none">
<div class="form-message__icon">
<img src="../../../assets/resource/lp/Group%20664.png" alt="" />
</div>
<div class="form-message__inner">
<div
class="form-message__title titleL"
data-lang="lng-form-error-title"
>
Something went wrong...
</div>
<div class="form-message__actions">
<p
class="button CTABase"
data-role="free-brokerage-request-reset"
data-lang="lng-form-error-button"
>
Please try again
</p>
</div>
</div>
</div>
<!-- Форма -->
<form
class="form"
action="<!-- @secret API_URL -->/freeBrokerage"
data-role="free-brokerage-request"
data-name="free-brokerage-request"
data-widget="form"
>
<!-- Секция 1 -->
<div class="form__section">
<img
src="../../../assets/resource/lp/free-brokerage/form1.webp"
alt=""
class="form__icon"
/>
<div class="form__content">
<h3 class="form__title" data-lang="lng-form-title">
Introduce yourself 🚀
</h3>
<label>
<span data-lang="lng-name-label">What's your name?</span>
<input
type="text"
name="first_name"
id="free-brokerage-request-first_name"
placeholder="Your full name"
data-lang="lng-name-placeholder"
data-lang-type="input"
/>
</label>
<label>
<span data-lang="lng-email-label">Email</span>
<input
type="email"
name="email"
id="free-brokerage-request-email"
placeholder="your.email@example.com"
data-lang="lng-email-placeholder"
data-lang-type="input"
/>
</label>
<label>
<span data-lang="lng-phone-label">Phone Number</span>
<input
type="text"
name="phone"
id="free-brokerage-request-phone"
placeholder="+1 234 567 8900"
data-lang="lng-phone-placeholder"
data-lang-type="input"
/>
</label>
<label>
<span data-lang="lng-telegram-label">Telegram</span>
<input
type="text"
name="tg"
id="free-brokerage-request-tg"
placeholder="@username"
data-lang="lng-telegram-placeholder"
data-lang-type="input"
/>
</label>
<label>
<span data-lang="lng-business-label"
>What's your current business?</span
>
<input
type="text"
name="company_name"
id="free-brokerage-request-company_name"
placeholder="Optional"
data-lang="lng-business-placeholder"
data-lang-type="input"
/>
</label>
<label>
<span data-lang="lng-why-brokerage-label"
>Why do you want to start your own brokerage?</span
>
<textarea
class="form__textarea"
name="short_bio"
id="free-brokerage-request-short_bio"
placeholder="Brief description about yourself"
data-lang="lng-description-label"
data-lang-type="input"
></textarea>
</label>
</div>
</div>
<!-- Секция 2 -->
<div class="form__section">
<div class="form__content">
<div class="form__header">
<h3 class="form__title" data-lang="lng-community-label">
Do you have your community? 👥
</h3>
<p class="form__subtitle" data-lang="lng-social-links-label">
Share links to social media profiles
</p>
</div>
<label>
<span data-lang="lng-tg-label">TG</span>
<input
type="text"
name="tg_channel"
id="free-brokerage-request-tg_channel"
placeholder="Telegram channel or group link"
data-lang="lng-tg-placeholder"
data-lang-type="input"
/>
</label>
<label>
<span data-lang="lng-insta-label">Insta</span>
<input
type="text"
name="instagram"
id="free-brokerage-request-instagram"
placeholder="Instagram profile link"
data-lang="lng-insta-placeholder"
data-lang-type="input"
/>
</label>
<label>
<span data-lang="lng-youtube-label">YouTube</span>
<input
type="text"
name="youtube"
id="free-brokerage-request-youtube"
placeholder="YouTube channel link"
data-lang="lng-youtube-placeholder"
data-lang-type="input"
/>
</label>
<label>
<span data-lang="lng-tiktok-label">TikTok</span>
<input
type="text"
name="tiktok"
id="free-brokerage-request-tiktok"
placeholder="TikTok profile link"
data-lang="lng-tiktok-placeholder"
data-lang-type="input"
/>
</label>
</div>
<img
src="../../../assets/resource/lp/free-brokerage/form2.webp"
alt=""
class="form__icon"
/>
</div>
<!-- Секция 3 -->
<div class="form__section-group">
<img
src="../../../assets/resource/lp/free-brokerage/form3.webp"
alt=""
class="form__icon"
/>
<div>
<!-- Регионы -->
<div class="form__section">
<h3 class="form__title" data-lang="lng-regions-label">
What are you target regions 🌍
</h3>
<div class="form__checkboxes">
<label>
<input type="checkbox" name="regions[]" value="4" />
<span data-lang="lng-region-latam">LATAM</span>
</label>
<label>
<input type="checkbox" name="regions[]" value="3" />
<span data-lang="lng-region-asia">Asia</span>
</label>
<label>
<input type="checkbox" name="regions[]" value="6" />
<span data-lang="lng-region-middle-east">Middle East</span>
</label>
<label>
<input type="checkbox" name="regions[]" value="5" />
<span data-lang="lng-region-africa">Africa</span>
</label>
</div>
</div>
<!-- Опыт -->
<div class="form__section">
<h3 class="form__title" data-lang="lng-experience-label">
Your experience 💼
</h3>
<label>
<span data-lang="lng-ftd-label"
>How many FTDs can you bring monthly?</span
>
<input
type="text"
name="ftd_sum"
id="free-brokerage-request-ftd_sum"
placeholder="Number of FTDs"
data-lang="lng-ftd-placeholder"
data-lang-type="input"
/>
</label>
<label>
<span data-lang="lng-budget-label"
>💰 What's your monthly marketing budget?</span
>
<div class="form__range-wrapper">
<div class="form__range-container">
<input
type="range"
name="range"
min="2"
max="6"
value="3"
step="1"
class="form__range"
/>
<div class="form__range-thumb">
<div class="form__range-thumb-inner"></div>
</div>
<div class="form__range-marks">
<button
type="button"
class="form__range-mark"
data-value="2"
></button>
<button
type="button"
class="form__range-mark"
data-value="3"
></button>
<button
type="button"
class="form__range-mark"
data-value="4"
></button>
<button
type="button"
class="form__range-mark"
data-value="5"
></button>
<button
type="button"
class="form__range-mark"
data-value="6"
></button>
</div>
</div>
<div class="form__range-labels">
<span data-lang="lng-budget-5000">$5 000</span>
<span data-lang="lng-budget-10000">$10 000</span>
<span data-lang="lng-budget-25000">$25 000</span>
<span data-lang="lng-budget-50000">$50 000</span>
<span data-lang="lng-budget-100000">$100 000+</span>
</div>
</div>
</label>
<label>
<span data-lang="lng-network-label"
>🤝 Do you have a network of investors or affiliates?</span
>
<div class="form__toggle-group">
<input type="hidden" name="has_network" value="yes" />
<button
type="button"
class="form__toggle-btn active"
data-value="yes"
data-lang="lng-yes"
>
Yes
</button>
<button
type="button"
class="form__toggle-btn"
data-value="no"
data-lang="lng-no"
>
No
</button>
</div>
</label>
</div>
</div>
</div>
<!-- Submit секция -->
<div class="forms__submit">
<button type="submit" class="button" data-lang="lng-submit-button">
Submit Application
</button>
<label class="forms__submit-checkbox">
<input
type="checkbox"
name="terms_agree"
class="forms__submit-checkbox-input"
required
/>
<span class="forms__submit-checkbox-icon"></span>
<span class="forms__submit-checkbox-text" data-lang="lng-terms-agree">
I read and agree with
<a href="/terms-and-conditions" target="_blank"
>terms and conditions</a
>
and <a href="/privacy-policy" target="_blank">privacy policy</a> of
this website
</span>
</label>
<div class="form__wrapper recaptcha">
<div class="form-field">
<div
id="free-brokerage-request-g-recaptcha-response"
class="captchaWrapper"
></div>
<div class="form-field__error">Required</div>
</div>
</div>
</div>
<script>
function recaptchaCallback() {
const reCaptchaOptions = {
sitekey: "6LceR2gjAAAAAIY2W8wlNB221ijjeTmLVfuFDma_",
};
if (
document.querySelector(
"#free-brokerage-request-g-recaptcha-response"
) !== null
) {
window.dataRequestFormCaptcha = grecaptcha.render(
"free-brokerage-request-g-recaptcha-response",
reCaptchaOptions
);
}
}
</script>
<script
src="https://www.google.com/recaptcha/api.js?onload=recaptchaCallback&render=explicit&hl=en"
async
defer
></script>
</form>
</div>
</section>