FormCallback Forms

---
// FormCallback, recovered from blurr-components.pages.dev
---

<div class="fcb-wrap"> <div class="fcb-header"> <div class="fcb-icon" aria-hidden="true">→</div> <h2 class="fcb-heading">Terugbelverzoek</h2> <p class="fcb-subtext">Laat je nummer achter en wij bellen je terug op het door jou gewenste tijdstip.</p> </div> <form class="fcb-form" novalidate> <div class="fcb-row"> <div class="fcb-field"> <label class="fcb-label" for="fcb-name">Naam *</label> <input class="fcb-input" type="text" id="fcb-name" name="name" placeholder="Jan de Vries" required autocomplete="name"> </div> <div class="fcb-field"> <label class="fcb-label" for="fcb-phone">Telefoonnummer *</label> <input class="fcb-input" type="tel" id="fcb-phone" name="phone" placeholder="+31 6 12 34 56 78" required autocomplete="tel"> </div> </div> <div class="fcb-row"> <div class="fcb-field"> <label class="fcb-label" for="fcb-date">Gewenste datum</label> <input class="fcb-input" type="date" id="fcb-date" name="callback_date"> </div> <div class="fcb-field"> <label class="fcb-label" for="fcb-time">Voorkeurstijdstip</label> <select class="fcb-select" id="fcb-time" name="callback_time"> <option value="">Geen voorkeur</option> <option>09:00 – 10:00</option> <option>10:00 – 11:00</option> <option>11:00 – 12:00</option> <option>13:00 – 14:00</option> <option>14:00 – 15:00</option> <option>15:00 – 16:00</option> <option>16:00 – 17:00</option> </select> </div> </div> <div class="fcb-field"> <label class="fcb-label" for="fcb-topic">Onderwerp gesprek</label> <input class="fcb-input" type="text" id="fcb-topic" name="topic" placeholder="Bijv. vrijblijvende kennismaking, offerte bespreken..."> </div> <button class="fcb-submit" type="submit">Terugbelverzoek versturen</button> </form> </div>

<style>
.fcb-wrap{max-width:520px;padding:2rem;background:#fff;border:1px solid #e5e5e5;border-radius:14px}
.fcb-header{margin-bottom:1.75rem}
.fcb-icon{font-size:2rem;margin-bottom:.75rem}
.fcb-heading{font-size:1.5rem;font-weight:800;color:var(--color-primary, #0a0a0a);margin:0 0 .4rem}
.fcb-subtext{font-size:.875rem;color:#666;margin:0}
.fcb-form{display:flex;flex-direction:column;gap:1.1rem}
.fcb-row{display:grid;grid-template-columns:1fr 1fr;gap:1rem}
.fcb-row{grid-template-columns:1fr}
.fcb-field{display:flex;flex-direction:column;gap:.35rem}
.fcb-label{font-size:.82rem;font-weight:600;color:var(--color-primary, #0a0a0a)}
.fcb-input,.fcb-select{padding:.7rem .9rem;border:1.5px solid #ddd;border-radius:8px;font-size:.925rem;color:var(--color-primary, #0a0a0a);background:#fff;transition:border-color .2s;font-family:inherit;box-sizing:border-box;width:100%}
.fcb-input:focus,.fcb-select:focus{outline:none;border-color:var(--color-accent, #6366f1);box-shadow:0 0 0 3px #6366f11f}
.fcb-submit{padding:.875rem;background:var(--color-accent, #6366f1);color:#fff;border:none;border-radius:8px;font-size:.975rem;font-weight:600;cursor:pointer;transition:opacity .2s;margin-top:.25rem}
.fcb-submit:hover{opacity:.88}
</style>