<?php include'header.php'?>

<!-- ===== SYSTEM BREADCRUMB WITH BACKGROUND ===== -->
<nav class="breadcrumb-nav bg-overlay" style="background-image: url('assets/img/breadcrumb.png');">
  <div class="wrap">
    <ol class="breadcrumb-list">
      <li class="breadcrumb-item">
        <a href="#">Pickup Request</a>
      </li>
    </ol>
  </div>
</nav>

<div class="logistics-form-container">
  <h2 class="form-title">Please Fill the Below Form.</h2>
  <form action="#" method="POST" onsubmit="event.preventDefault();">
    <div class="logistics-form-grid">
      
      <!-- Full Name -->
      <div class="logistics-input-box">
        <label>Full Name *</label>
        <input type="text" placeholder="Enter sender or company name" required>
      </div>

      <!-- Phone No. -->
      <div class="logistics-input-box">
        <label>Phone No. *</label>
        <input type="tel" placeholder="Enter contact verification line" required>
      </div>

      <!-- Goods Type -->
      <div class="logistics-input-box">
        <label>Goods Type</label>
        <input type="text" placeholder="e.g. Industrial Equipment, Electronics">
      </div>

      <!-- Weight -->
      <div class="logistics-input-box">
        <label>Weight *</label>
        <input type="text" placeholder="Estimated metrics in KG / Tons" required>
      </div>

      <!-- Address -->
      <div class="logistics-input-box">
        <label>Address *</label>
        <input type="text" placeholder="Complete destination footprint" required>
      </div>

      <!-- Image Captcha Row Alignment -->
      <div class="captcha-flex-group">
        <div class="logistics-input-box">
          <label>Security Token</label>
          <div class="captcha-visual-pane">
            <div class="captcha-graphic">
              <!-- Inline placeholder replicating image captcha token context -->
              <img src="captcha.jpg" alt="7NY4L verification string">
            </div>
            <button type="button" class="captcha-refresh-btn" title="Generate New Key">
              <svg viewBox="0 0 24 24">
                <path d="M19 8l-4 4h3c0 3.31-2.69 6-6 6a5.87 5.87 0 0 1-2.8-.7l-1.46 1.46A7.93 7.93 0 0 0 12 20c4.42 0 8-3.58 8-8h3l-4-4zM6 12c0-3.31 2.69-6 6-6 1.01 0 1.97.25 2.8.7l1.46-1.46A7.93 7.93 0 0 0 12 4c-4.42 0-8 3.58-8 8H1l4 4 4-4H6z"/>
              </svg>
            </button>
          </div>
        </div>

        <div class="logistics-input-box">
          <label>Enter Captcha *</label>
          <input type="text" placeholder="Verify exact characters" required>
        </div>
      </div>

      <!-- Form Submission Trigger -->
      <div style="margin-top: 12px;">
        <button type="submit" class="btn btn-solid" style="width: 100%; border: none;">
          Submit Request
        </button>
      </div>

    </div>
  </form>
</div>

<style>
    /* --- PREMIUM LOGISTICS CALCULATION FORM --- */
.logistics-form-container {
  max-width: 600px;
  margin: 40px auto;
  padding: 40px;
  background: var(--paper);
  border: 2px solid var(--ink);
  box-shadow: 6px 6px 0 var(--ink);
}

.logistics-form-grid {
  display: flex;
  flex-direction: column;
  gap: 20px;
}

.logistics-input-box {
  display: flex;
  flex-direction: column;
  gap: 6px;
}

.logistics-input-box label {
  font-family: 'IBM Plex Mono', monospace;
  font-size: 11px;
  text-transform: uppercase;
  color: var(--muted);
  font-weight: 600;
  letter-spacing: 0.05em;
}

/* Form Controls */
.logistics-input-box input,
.logistics-input-box select {
  width: 100%;
  padding: 14px 16px;
  font-family: inherit;
  font-size: 15px;
  border: 2px solid var(--ink);
  background: var(--paper);
  color: var(--ink);
  outline: none;
  box-sizing: border-box;
  appearance: none; /* Removes native OS select styles */
  transition: background-color 0.2s;
}

.logistics-input-box input:focus,
.logistics-input-box select:focus {
  background: #ffffff;
}

/* Custom dropdown icon container */
.select-wrapper {
  position: relative;
  width: 100%;
}

.select-wrapper::after {
  content: "▼";
  font-size: 10px;
  position: absolute;
  right: 16px;
  top: 50%;
  transform: translateY(-50%);
  color: var(--ink);
  pointer-events: none;
}

/* Image Captcha Integration Module */
.captcha-flex-group {
  display: grid;
  grid-template-columns: auto auto 1fr;
  gap: 16px;
  align-items: flex-end;
}

.captcha-visual-pane {
  display: flex;
  align-items: center;
  gap: 12px;
}

.captcha-graphic {
  border: 2px solid var(--ink);
  background: #ffffff;
  height: 49px;
  padding: 0 8px;
  display: flex;
  align-items: center;
}

.captcha-graphic img {
  height: 80%;
  width: auto;
}

.captcha-refresh-btn {
  background: none;
  border: 2px solid var(--ink);
  height: 49px;
  width: 49px;
  display: flex;
  align-items: center;
  justify-content: center;
  cursor: pointer;
  background: var(--paper);
  box-shadow: 2px 2px 0 var(--ink);
  transition: transform 0.1s, box-shadow 0.1s;
}

.captcha-refresh-btn:hover {
  transform: translate(-1px, -1px);
  box-shadow: 3px 3px 0 var(--ink);
}

.captcha-refresh-btn svg {
  width: 20px;
  height: 20px;
  fill: var(--ink);
}

/* Responsive Breakdown */
@media (max-width: 560px) {
  .logistics-form-container {
    padding: 24px;
  }
  .captcha-flex-group {
    grid-template-columns: 1fr;
    gap: 16px;
  }
  .captcha-visual-pane {
    width: 100%;
    justify-content: space-between;
  }
  .captcha-graphic {
    flex-grow: 1;
    justify-content: center;
  }
}
</style>

<?php include'footer.php'?>