<section style="padding: 48px 0; max-width: 640px; margin: 0 auto;">
  <div class="form-panel">
    <div class="section-heading form-section">
      <span class="eyebrow">Start your order</span>
      <h1>Request an order</h1>
      <p>
        Enter your email address and jurisdiction number below. We'll email you a
        secure link to continue your order.
      </p>
    </div>

    <form method="post" class="form-section" action="<%= H(Routes().AppURL & "request-order") %>">
      <input type="hidden" name="csrf_token" value="<%= H(csrfToken) %>" />

      <div class="form-group" style="margin-bottom: 16px;">
        <label for="Email">Email address</label>
        <input type="email" class="form-control" id="Email" name="Email" required
               value="<%= H(emailValue) %>" />
      </div>

      <div class="form-group" style="margin-bottom: 24px;">
        <label for="JurisdictionNumber">Jurisdiction number</label>
        <input type="text" class="form-control" id="JurisdictionNumber" name="JurisdictionNumber" required
               value="<%= H(jurisdictionValue) %>" />
      </div>

      <div class="cf-turnstile" style="margin-bottom: 24px;" data-sitekey="<%= H(turnstileSiteKey) %>"></div>

      <button type="submit" class="button button-primary">Request order</button>
    </form>
  </div>
</section>

<script src="https://challenges.cloudflare.com/turnstile/v0/api.js" async defer></script>
