<!doctype html>
<html lang="en">
<head>
  <meta charset="utf-8" />
  <meta name="viewport" content="width=device-width, initial-scale=1" />
  <title>Submit Enrich Data — Ringba</title>
  <link href="https://cdn.jsdelivr.net/npm/bootstrap@5.3.2/dist/css/bootstrap.min.css" rel="stylesheet" crossorigin="anonymous">
  <style>
    body {
      background: linear-gradient(135deg, #f8f9fa, #e9ecef);
    }
    .card {
      border-radius: 1rem;
    }
    .btn-primary {
      border-radius: 50px;
      padding-left: 2rem;
      padding-right: 2rem;
    }
  </style>
</head>
<body>
  <div class="container py-5">
    <div class="row justify-content-center">
      <div class="col-md-7 col-lg-6">
        <div class="card shadow-lg border-0">
          <div class="card-body p-5">
            <h3 class="card-title mb-4 text-center">Send Data</h3>

            <form id="enrichForm" method="get" action="https://display.ringba.com/enrich/2775643530473768583" target="_blank">

              <div class="mb-3">
                <label for="callerid" class="form-label">Caller ID</label>
                <input type="tel" class="form-control form-control-lg" id="callerid" name="callerid" placeholder="Enter Caller ID" required>
              </div>

              <div class="mb-3">
                <label for="ZipCode" class="form-label">Zip Code</label>
                <input type="text" class="form-control form-control-lg" id="ZipCode" name="ZipCode" placeholder="Enter Zip Code">
              </div>

              <div class="mb-3">
                <label for="Age" class="form-label">Age</label>
                <input type="number" class="form-control form-control-lg" id="Age" name="Age" placeholder="Enter Age" min="0">
              </div>

              <div class="mb-3">
                <label for="agentname" class="form-label">Agent Name</label>
                <input type="text" class="form-control form-control-lg" id="agentname" name="agentname" placeholder="Enter Agent Name">
              </div>

              <!-- Hidden exposeCallerId field defaulted to yes -->
              <input type="hidden" id="exposeCallerId" name="exposeCallerId" value="yes">

              <div class="d-grid mt-4">
                <button type="submit" class="btn btn-primary">Submit</button>
              </div>

            </form>
          </div>
        </div>
      </div>
    </div>
  </div>
</body>
</html>
