<div id="slo-mo-placement-form" style="max-width:600px;margin:40px auto;background:#000;padding:30px;border:2px solid #d4af37;">
<h2 style="color:#d4af37;text-align:center;margin:0 0 20px 0;font-size:24px;font-weight:900;">FREEZER PLACEMENT PROGRAM</h2>
<p style="color:#fff;text-align:center;margin:0 0 30px 0;font-size:14px;">WHOLESALE ONLY. ONE FREEZER PER TERRITORY.</p>
<form id="placementForm" onsubmit="submitPlacement(event)">
<label style="color:#d4af37;display:block;margin-bottom:8px;font-weight:700;">ZIP CODE *</label>
<input type="text" id="zip" name="zip" required pattern="[0-9]{5}" placeholder="10036" style="width:100%;padding:12px;margin-bottom:20px;background:#111;border:1px solid #333;color:#fff;font-size:16px;">
<label style="color:#d4af37;display:block;margin-bottom:8px;font-weight:700;">STORE TYPE *</label>
<select id="storeType" name="storeType" required style="width:100%;padding:12px;margin-bottom:20px;background:#111;border:1px solid #333;color:#fff;font-size:16px;">
<option value="">Select Type</option>
<option value="Bodega">Bodega / Corner Store</option>
<option value="Dealership">Auto Dealership</option>
<option value="Campus">Campus Retail</option>
<option value="Transit">Transit-Adjacent</option>
<option value="QSR">QSR / Restaurant</option>
<option value="C-Store">High-Volume C-Store</option>
</select>
<label style="color:#d4af37;display:block;margin-bottom:8px;font-weight:700;">EST. DAILY FOOT TRAFFIC</label>
<select id="traffic" name="traffic" style="width:100%;padding:12px;margin-bottom:20px;background:#111;border:1px solid #333;color:#fff;font-size:16px;">
<option value="">Select Range</option>
<option value="Under 200">Under 200</option>
<option value="200-500">200 - 500</option>
<option value="500-1000">500 - 1,000</option>
<option value="1000+">1,000+</option>
</select>
<label style="color:#d4af37;display:block;margin-bottom:8px;font-weight:700;">INSTAGRAM @ OR PHONE *</label>
<input type="text" id="contact" name="contact" required placeholder="@yourstore or 212-555-0000" style="width:100%;padding:12px;margin-bottom:30px;background:#111;border:1px solid #333;color:#fff;font-size:16px;">
<button type="submit" style="width:100%;background:#d4af37;color:#000;padding:18px;border:none;font-size:18px;font-weight:900;cursor:pointer;">CHECK TERRITORY</button>
</form>
<p style="color:#666;text-align:center;margin:20px 0 0 0;font-size:12px;">By submitting, you agree to program terms. No prep. No labor. 40-55% margin.</p>
</div>
<script>
function submitPlacement(e) {
e.preventDefault();
const zip = document.getElementById('zip').value;
const storeType = document.getElementById('storeType').value;
const traffic = document.getElementById('traffic').value;
const contact = document.getElementById('contact').value;
const message = `PLACEMENT CHECK%0AZip: ${zip}%0AType: ${storeType}%0ATraffic: ${traffic}%0AContact: ${contact}`;
// Redirects to IG DM with prefilled message
window.open(`https://ig.me/m/slomoxzotic?text=${message}`, '_blank');
// Optional: Show confirmation
document.getElementById('placementForm').innerHTML = '<p style="color:#d4af37;text-align:center;font-size:18px;font-weight:700;">TERRITORY CHECK SENT.<br>Check your IG DMs for response.</p>';
}
</script>