512 lines
15 KiB
Plaintext
512 lines
15 KiB
Plaintext
---
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import ContactObfuscation from './ContactObfuscation.astro';
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type ServiceKey = 'aba-therapy' | 'autism-evaluations' | 'learner-social-club';
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interface Props {
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service: ServiceKey;
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}
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const serviceCopy: Record<ServiceKey, {
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heading: string[];
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serviceName: string;
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statusLead: string;
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status: string;
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prompt: string;
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}> = {
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'aba-therapy': {
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heading: ['No WAITLIST!'],
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serviceName: 'ABA Therapy',
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statusLead: 'is',
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status: 'currently accepting new patients',
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prompt: "To help guarantee your child's admission to our program, please provide their information."
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},
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'autism-evaluations': {
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heading: ['Enrollment', 'Now Open'],
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serviceName: 'Autism Evaluations',
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statusLead: 'are',
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status: 'now open for enrollment',
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prompt: "To help guarantee your child's admission into one of our upcoming programs, please provide their information."
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},
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'learner-social-club': {
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heading: ['Enrollment', 'Now Open'],
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serviceName: 'Learner Social Club',
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statusLead: 'is',
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status: 'now open for enrollment',
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prompt: "To help guarantee your child's spot in one of our upcoming group enrichment programs, please provide their information."
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}
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};
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const { service } = Astro.props;
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const copy = serviceCopy[service];
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const drawerId = `service-inquiry-${service}`;
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const titleId = `${drawerId}-title`;
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const noteId = `${drawerId}-note`;
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---
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<dialog
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class="service-inquiry-drawer"
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data-service-inquiry-drawer
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data-dismiss-key={`aia-service-inquiry-dismissed:${service}`}
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aria-labelledby={titleId}
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>
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<button class="service-inquiry-drawer__close" type="button" data-service-inquiry-close aria-label="Close inquiry form">
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<svg aria-hidden="true" viewBox="0 0 32 32" width="18" height="18">
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<path d="M4 4 28 28M28 4 4 28" fill="none" stroke="currentColor" stroke-linecap="round" stroke-width="3" />
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</svg>
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</button>
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<header class="service-inquiry-drawer__intro">
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<h2 id={titleId} data-service-inquiry-title tabindex="-1">
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{copy.heading.map((line, index) => <Fragment>{index > 0 && <br />}{line}</Fragment>)}
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</h2>
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<p>
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Arizona Institute for Autism's<br />
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<strong>{copy.serviceName}</strong><br />
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{copy.statusLead} <em>{copy.status}</em>.
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</p>
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<p>{copy.prompt}</p>
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</header>
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<form class="service-inquiry-form" method="post" action="">
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<!-- TODO: Wire this form to Netlify Forms, a custom API endpoint, or another backend service. -->
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<!-- TODO: Add spam protection before production launch. -->
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<div class="service-inquiry-form__grid">
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<label>
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<span>First Name<span class="required-mark" aria-hidden="true">*</span></span>
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<input name="first_name" autocomplete="given-name" required />
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</label>
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<label>
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<span>Last Name<span class="required-mark" aria-hidden="true">*</span></span>
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<input name="last_name" autocomplete="family-name" required />
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</label>
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<label>
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<span>Phone Number<span class="required-mark" aria-hidden="true">*</span></span>
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<span class="service-inquiry-form__phone">
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<span class="service-inquiry-form__country">
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<span aria-hidden="true">🇺🇸</span>
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<span class="service-inquiry-form__country-caret" aria-hidden="true"></span>
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<span class="visually-hidden">United States country code</span>
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</span>
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<span class="service-inquiry-form__phone-number">
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<span aria-hidden="true">+1</span>
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<input type="tel" name="phone" autocomplete="tel-national" required />
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</span>
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</span>
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</label>
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<label>
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<span>Email<span class="required-mark" aria-hidden="true">*</span></span>
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<input type="email" name="email" autocomplete="email" required />
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</label>
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<label>
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<span>Child First Name</span>
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<input name="child_first_name" autocomplete="off" />
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</label>
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<label>
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<span>Child Last Name</span>
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<input name="child_last_name" autocomplete="off" />
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</label>
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<label class="service-inquiry-form__wide">
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<span>Child Birth Date</span>
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<input name="child_birth_date" inputmode="numeric" autocomplete="bday" placeholder="MM - DD - YYYY" />
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</label>
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<label>
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<span>Location Interest</span>
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<select name="location_interest">
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<option value="" selected>Please Select</option>
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<option value="aia_scottsdale">AIA Scottsdale</option>
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<option value="aia_glendale">AIA Glendale</option>
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<option value="other_none">Other/None</option>
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</select>
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</label>
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<label>
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<span>Service Interest</span>
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<select name="service_interest">
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<option value="" selected>Please Select</option>
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<option value="behavioral">Behavioral - ABA Therapy Service</option>
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<option value="psychological">Psychological - Autism Evaluation Service</option>
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<option value="sociological">Sociological - Learners Social Club Service</option>
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<option value="other_none">Other/None</option>
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</select>
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</label>
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<label>
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<span>Insurance & Payment Options</span>
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<select name="payment_options">
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<option value="" selected>Please select</option>
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<option>United Healthcare AHCCCS</option>
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<option>BCBS AZ</option>
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<option>United Healthcare</option>
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<option>Optum</option>
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<option>Tricare</option>
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<option>Care Credit</option>
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<option>Private Pay</option>
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<option value="Other">Other (please describe in comment)</option>
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</select>
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</label>
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<label>
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<span>How did you hear about us?</span>
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<select name="referred_by">
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<option value="" selected>Please select</option>
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<option>Facebook</option>
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<option>Google</option>
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<option>Primary Doctor</option>
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<option value="Specialist">Specialist (e.g., Developmental Psychologist)</option>
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<option>Client Referral</option>
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<option>Community Event</option>
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<option value="Other">Other (please describe in comment)</option>
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</select>
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</label>
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<label class="service-inquiry-form__wide">
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<span>Additional Information/Comments</span>
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<textarea name="comment" rows="2"></textarea>
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</label>
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</div>
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<div class="service-inquiry-form__footer">
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<p id={noteId}>Online submission is not yet connected. Please call <ContactObfuscation phone="(480) 687-7099" hrefValue="+14806877099" obfuscatedText="9907-786 (084)" />.</p>
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<button type="submit" disabled aria-describedby={noteId}>Submit</button>
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</div>
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</form>
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</dialog>
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<script>
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const initializeServiceInquiryDrawers = () => {
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document.querySelectorAll('[data-service-inquiry-drawer]').forEach((element) => {
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if (!(element instanceof HTMLDialogElement) || element.dataset.initialized === 'true') return;
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element.dataset.initialized = 'true';
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const closeButton = element.querySelector('[data-service-inquiry-close]');
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const title = element.querySelector('[data-service-inquiry-title]');
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const dismissKey = element.dataset.dismissKey;
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const reduceMotion = window.matchMedia('(prefers-reduced-motion: reduce)');
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let closeTimer: number | undefined;
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const wasDismissed = () => {
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try {
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return dismissKey ? sessionStorage.getItem(dismissKey) === 'true' : false;
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} catch {
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return false;
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}
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};
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const rememberDismissal = () => {
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try {
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if (dismissKey) sessionStorage.setItem(dismissKey, 'true');
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} catch {
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// Storage can be unavailable in privacy-focused browsing modes.
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}
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};
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const finishClose = () => {
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if (element.open) element.close();
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document.documentElement.classList.remove('service-inquiry-open');
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};
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const closeDrawer = () => {
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if (!element.open) return;
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rememberDismissal();
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element.classList.remove('is-open');
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window.clearTimeout(closeTimer);
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if (reduceMotion.matches) {
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finishClose();
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return;
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}
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closeTimer = window.setTimeout(finishClose, 500);
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};
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const openDrawer = () => {
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if (element.open || wasDismissed()) return;
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element.showModal();
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document.documentElement.classList.add('service-inquiry-open');
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requestAnimationFrame(() => requestAnimationFrame(() => {
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element.classList.add('is-open');
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if (title instanceof HTMLElement) title.focus({ preventScroll: true });
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}));
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};
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closeButton?.addEventListener('click', closeDrawer);
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element.addEventListener('cancel', (event) => {
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event.preventDefault();
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closeDrawer();
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});
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element.addEventListener('click', (event) => {
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if (event.target === element) closeDrawer();
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});
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element.addEventListener('close', () => {
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element.classList.remove('is-open');
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document.documentElement.classList.remove('service-inquiry-open');
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});
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window.setTimeout(openDrawer, 10_000);
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});
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};
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initializeServiceInquiryDrawers();
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</script>
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<style>
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:global(html.service-inquiry-open) {
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overflow: hidden;
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}
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.service-inquiry-drawer {
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background: white;
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border: 0;
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border-radius: 4px;
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box-sizing: border-box;
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color: var(--color-primary);
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font-family: var(--font-body);
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inset: 10px 10px auto auto;
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margin: 0;
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max-height: calc(100dvh - 20px);
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max-width: calc(100vw - 20px);
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opacity: 0;
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overflow-y: auto;
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padding: 0;
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transform: translateX(calc(100% + 20px));
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transition: opacity 300ms ease, transform 500ms ease;
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width: 608px;
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}
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.service-inquiry-drawer.is-open {
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opacity: 1;
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transform: translateX(0);
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}
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.service-inquiry-drawer::backdrop {
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background: rgb(0 0 0 / 56%);
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opacity: 0;
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transition: opacity 300ms ease;
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}
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.service-inquiry-drawer.is-open::backdrop {
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opacity: 1;
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}
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.service-inquiry-drawer__close {
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align-items: center;
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background: transparent;
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border: 0;
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color: black;
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cursor: pointer;
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display: flex;
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justify-content: center;
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padding: 10px;
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position: absolute;
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right: 10px;
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top: 10px;
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z-index: 1;
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}
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.service-inquiry-drawer__close:focus-visible {
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outline: 2px solid var(--color-primary);
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outline-offset: 2px;
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}
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.service-inquiry-drawer__intro {
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padding: 24px 60px 0;
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text-align: center;
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}
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.service-inquiry-drawer__intro h2 {
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font-family: var(--font-body);
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font-size: 1.625rem;
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line-height: 1.05;
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margin: 10px 0 16px;
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outline: none;
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}
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.service-inquiry-drawer__intro p {
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line-height: 1.2;
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margin: 0 0 16px;
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}
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.service-inquiry-drawer__intro p:last-child {
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margin-bottom: 0;
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}
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.service-inquiry-form {
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padding: 48px 60px 60px;
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}
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.service-inquiry-form__grid {
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display: grid;
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gap: 18px 30px;
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grid-template-columns: repeat(2, minmax(0, 1fr));
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}
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.service-inquiry-form label {
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display: grid;
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font-weight: 400;
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gap: 7px;
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line-height: 1.2;
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min-width: 0;
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}
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.required-mark {
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color: #e51520;
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}
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.service-inquiry-form input,
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.service-inquiry-form select,
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.service-inquiry-form textarea {
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background: #f5f8fa;
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border: 1px solid #959494;
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border-radius: 3px;
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box-sizing: border-box;
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color: #21303d;
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font: inherit;
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min-height: 41px;
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padding: 10px;
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width: 100%;
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}
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.service-inquiry-form input::placeholder,
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.service-inquiry-form textarea::placeholder {
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color: rgb(81 99 131 / 64%);
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}
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.service-inquiry-form select {
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appearance: none;
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background-image: url("data:image/svg+xml,%3Csvg xmlns='http://www.w3.org/2000/svg' viewBox='0 0 10 6'%3E%3Cpath fill='%2321303d' d='M0 0h10L5 6z'/%3E%3C/svg%3E");
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background-position: right 12px center;
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background-repeat: no-repeat;
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background-size: 10px 6px;
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color: rgb(81 99 131 / 70%);
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padding-right: 34px;
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}
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.service-inquiry-form textarea {
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min-height: 58px;
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resize: vertical;
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}
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.service-inquiry-form__wide {
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grid-column: 1 / -1;
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}
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.service-inquiry-form__phone {
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display: grid;
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grid-template-columns: auto minmax(0, 1fr);
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}
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.service-inquiry-form__phone input {
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background: transparent;
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border: 0;
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border-bottom-left-radius: 0;
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border-top-left-radius: 0;
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min-width: 0;
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padding-left: 6px;
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}
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.service-inquiry-form__country {
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align-items: center;
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background: #f5f8fa;
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border: 1px solid #959494;
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border-radius: 3px 0 0 3px;
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color: #21303d;
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display: flex;
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gap: 7px;
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padding: 0 10px;
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}
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.service-inquiry-form__country-caret {
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border-left: 5px solid transparent;
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border-right: 5px solid transparent;
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border-top: 6px solid #21303d;
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height: 0;
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width: 0;
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}
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.service-inquiry-form__phone-number {
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align-items: center;
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background: #f5f8fa;
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border: 1px solid #959494;
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border-left: 0;
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border-radius: 0 3px 3px 0;
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color: #21303d;
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display: grid;
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grid-template-columns: auto minmax(0, 1fr);
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padding-left: 10px;
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}
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.visually-hidden {
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clip: rect(0 0 0 0);
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clip-path: inset(50%);
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height: 1px;
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overflow: hidden;
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position: absolute;
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white-space: nowrap;
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width: 1px;
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}
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.service-inquiry-form__footer {
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align-items: end;
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display: grid;
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gap: 20px;
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grid-template-columns: minmax(0, 1fr) auto;
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margin-top: 40px;
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}
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.service-inquiry-form__footer p {
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color: var(--color-primary);
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font-size: .8rem;
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line-height: 1.35;
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margin: 0;
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}
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.service-inquiry-form__footer button {
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background: var(--color-accent-strong);
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border: 0;
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border-radius: 3px;
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color: white;
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font: inherit;
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font-weight: 700;
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opacity: 1;
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padding: 12px 24px;
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}
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.service-inquiry-form__footer button:disabled {
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cursor: not-allowed;
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}
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@media (max-width: 500px) {
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.service-inquiry-drawer__intro {
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padding-top: 20px;
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}
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.service-inquiry-form__grid {
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grid-template-columns: 1fr;
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}
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.service-inquiry-form__wide {
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grid-column: auto;
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}
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.service-inquiry-form__footer {
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align-items: stretch;
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grid-template-columns: 1fr;
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}
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.service-inquiry-form__footer button {
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justify-self: end;
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}
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}
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@media (max-width: 360px) {
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.service-inquiry-drawer__intro,
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.service-inquiry-form {
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padding-inline: 32px;
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}
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}
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@media (prefers-reduced-motion: reduce) {
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.service-inquiry-drawer,
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.service-inquiry-drawer::backdrop {
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transition: none;
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}
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}
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</style>
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