*{
  box-sizing:border-box;
}

html,
body{
  margin:0;
  padding:0;
  background:#000;
  color:#fff;
  font-family:Arial,sans-serif;
}

body{
  width:100%;
  max-width:30rem;
  margin:0 auto;
}

main{
  background:#000;
  padding:1rem;
}

.back-wrap{
  display:flex;
  justify-content:center;
  width:100%;
  margin:0 0 2rem;
}

.back-wrap.bottom{
  margin:2rem 0 0;
}

.back-btn{
  display:flex;
  align-items:center;
  justify-content:center;
  width:90%;
  padding:1rem 1.5rem;
  border:2px solid #10EA22;
  border-radius:5rem;
  background:#000;
  color:#fff;
  text-decoration:none;
  font-size:1rem;
  line-height:1.5rem;
}

.request-wrap{
  width:100%;
}

.request-heading{
  text-align:center;
  padding:0 .75rem 1.5rem;
}

.request-kicker{
  color:#10EA22;
  font-size:.72rem;
  font-weight:700;
  letter-spacing:.16rem;
  margin-bottom:.65rem;
}

.request-heading h1{
  margin:0 0 .7rem;
  color:#fff;
  font-size:1.7rem;
}

.request-heading p{
  margin:0 auto;
  color:#fff;
  opacity:.85;
  font-size:.9rem;
  line-height:1.55;
  max-width:24rem;
}

form{
  width:100%;
}

.field{
  margin-bottom:1.15rem;
}

.field label,
.providers legend{
  display:block;
  color:#fff;
  font-size:.85rem;
  font-weight:700;
  margin-bottom:.45rem;
}

.field label span{
  color:#10EA22;
}

input,
select{
  width:100%;
  min-height:48px;
  padding:.8rem .9rem;
  border:2px solid #10EA22;
  border-radius:.65rem;
  background:#fff;
  color:#000;
  font-size:.95rem;
  outline:none;
}

input:focus,
select:focus{
  box-shadow:0 0 0 3px rgba(16,234,34,.15);
}

.providers{
  margin:0 0 1.15rem;
  padding:1rem;
  border:2px solid #10EA22;
  border-radius:1rem;
}

.providers legend{
  padding:0 .35rem;
}

.helper{
  margin:-.1rem 0 .75rem;
  color:#fff;
  opacity:.68;
  font-size:.75rem;
}

.check-row{
  display:flex;
  align-items:center;
  gap:.75rem;
  padding:.65rem 0;
  color:#fff;
  font-size:.88rem;
  cursor:pointer;
}

.check-row + .check-row{
  border-top:1px solid rgba(255,255,255,.10);
}

.check-row input{
  appearance:none;
  -webkit-appearance:none;
  width:21px;
  min-width:21px;
  height:21px;
  min-height:21px;
  padding:0;
  margin:0;
  border:2px solid #10EA22;
  border-radius:4px;
  background:#000;
  cursor:pointer;
  position:relative;
}

.check-row input:checked{
  background:#10EA22;
}

.check-row input:checked::after{
  content:"✓";
  position:absolute;
  inset:0;
  display:flex;
  align-items:center;
  justify-content:center;
  color:#000;
  font-size:.85rem;
  font-weight:900;
}

.time-grid{
  display:grid;
  grid-template-columns:1fr 1fr 1fr;
  gap:.55rem;
}

.sub-label{
  display:block;
  color:#fff;
  opacity:.75;
  font-size:.72rem;
  margin:0 0 .35rem .1rem;
}

.submit-btn{
  width:100%;
  margin-top:.35rem;
  padding:1rem 1.25rem;
  border:2px solid #10EA22;
  border-radius:5rem;
  background:#000;
  color:#fff;
  font-size:.95rem;
  font-weight:700;
  cursor:pointer;
}

.submit-btn:hover{
  background:#10EA22;
  color:#000;
}

.form-message{
  color:#10EA22;
  font-size:.8rem;
  min-height:1rem;
  margin-bottom:.5rem;
  text-align:center;
}

footer{
  background:#000;
  color:#fff;
  padding:1.5rem;
  padding-top:0;
  text-align:center;
  font-size:.75rem;
}

footer a{
  color:#fff;
  text-decoration:underline;
}

@media(max-width:380px){
  .time-grid{
    grid-template-columns:1fr;
  }
}