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<div id="est-phone-number"></div>

<style>
  .estimate-form-inner-wrapper {
    display: flex;
    flex-direction: column;
    gap: 16px;
    margin-bottom: 0px !important;
  }

  .estimate-form-input-grid {
    display: grid;
    align-items: initial;
    grid-template-columns: 1fr 1fr;
    grid-gap: 16px;
  }

  .estimate-form-input-wrapper {
    display: flex;
    flex-direction: column;
    justify-content: flex-end;
  }

  .estimate-form-input-wrapper p {
    font-family: Inter;
    font-size: 14px;
    font-weight: 500;
    line-height: 21px;
    color: black;
    margin-bottom: 4px;
  }
  .estimate-form-input-wrapper span {
    color: red;
  }

  .estimate-form-input-wrapper input {
    padding: 8px 16px;
    border-radius: 4px;
    border: 0.5px solid rgba(163, 163, 163, 0.5);
    color: black;
    font-family: Inter;
    font-size: 16px;
    font-weight: 500;
    line-height: 24px;
  }

  .estimate-form-input-wrapper input::placeholder {
    color: #a3a3a3;
    font-family: Inter;
    font-size: 16px;
    font-weight: 500;
    line-height: 24px;
  }

  .estimate-submit-btn {
    padding: 12px 28px !important;
    border-radius: 999px !important;
    background-color: #043968 !important;
    background-color: var(--bricks-color-fvnfur)!important;
    font-size: 16px !important;
    font-weight: 700 !important;
    line-height: 24px !important;
    color: #ffffff !important;
    text-transform: uppercase !important;
    align-self: flex-start !important;
    transition: all 0.3s ease !important;
    cursor: pointer !important;
  }

  .estimate-submit-btn:hover {
    background-color: var(--bricks-color-ykxnnf) !important;
    color: white !important;
  }

  .wpcf7-form input[type="submit"].custom-estimate-submit-btn {
    padding: 12px 16px !important;
    border-radius: 8px !important;
    background-color: #043968 !important;
    font-family: "Filson pro" !important;
    font-size: 16px !important;
    font-weight: 700 !important;
    line-height: 24px !important;
    color: #95c93d !important;
    text-transform: uppercase !important;
    align-self: flex-start !important;
    transition: all 0.3s ease !important;
    cursor: pointer !important;
  }

  .wpcf7-form input[type="submit"].custom-estimate-submit-btn:hover {
    background-color: #7eb4a3 !important;
    color: white !important;
  }

  @media only screen and (max-width: 990px) {
    .estimate-form-wrapper {
      grid-template-columns: 1fr;
      grid-gap: 64px;
    }
  }

  @media only screen and (max-width: 477px) {
    .estimate-form-input-grid {
      grid-template-columns: 1fr;
    }
  }
</style>

<form method="post" class="estimate-form-inner-wrapper" id="seviceminder-form">
  <div class="estimate-form-input-grid">
    <div class="estimate-form-input-wrapper">
      <p>Name <span>*</span></p>
      <input
        type="text"
        id="name"
        name="Name"
        required
        placeholder="First Name"
      />
    </div>
    <div class="estimate-form-input-wrapper">
      <input type="text" name="lName" id="lName" placeholder="Last Name" />
    </div>
  </div>
  <div class="estimate-form-input-grid">
    <div class="estimate-form-input-wrapper">
      <p>Email <span>*</span></p>
      <input
        type="email"
        id="email"
    		name="Email"
        required
        placeholder="Enter Email"
      />
    </div>
    <div class="estimate-form-input-wrapper">
      <p>Phone Number <span>*</span></p>
      <input type="tel" id="phone" name="Phone1" maxLength=14 placeholder="Enter phone number" required/>
    </div>
  </div>
  <div class="estimate-form-input-grid">
    <div class="estimate-form-input-wrapper">
      <p>Address line 1</p>
      <input type="text" id="address1"
    name="Address1" />
    </div>
		<div class="estimate-form-input-wrapper">
      <p>Address line 2</p>
      <input type="text" id="address2"
    name="Address2" />
    </div>    
  </div>
  <div class="estimate-form-input-grid">
    <div class="estimate-form-input-wrapper">
      <p>City</p>
      <input type="text" aria-required="true"
        aria-invalid="false"
        id="city"
        name="City" />
    </div>
    <div class="estimate-form-input-wrapper">
      <p>State</p>
      <input type="text" aria-required="true"
      aria-invalid="false"
      id="state"
      name="State" />
    </div>
  </div>
  <div class="estimate-form-input-grid">
    <div class="estimate-form-input-wrapper">
      <p>Zip Code <span>*</span></p>
      <input type="text" id="postalcode"
      name="PostalCode" required />
    </div>
    <div class="estimate-form-input-wrapper">
    <input type="hidden" name="key" id="serviceminder-key" />
  </div>
  </div>
  <input
      type="hidden"
      id="RedirectUrlPopup"
      name="RedirectUrl"
    />
  <button type="submit" class="estimate-submit-btn" id="serviceminder-submit">
    Submit
  </button>
</form>