!-- Contact Form 7 Form Template -->
<div class="payment-request-form">
    <div class="form-group">
        <label for="email">Email Address *</label>
        [email* email id:email class:form-control placeholder "Enter your email address"]
    </div>

    <div class="form-group">
        <label for="withdraw-amount">Withdrawal Amount (Minimum $5) *</label>
        [number* withdraw-amount id:withdraw-amount class:form-control min:5 step:0.01 placeholder "Enter amount (min $5)"]
    </div>

    <div class="form-group">
        <label for="withdrawal-method">Withdrawal Method *</label>
        [select* withdrawal-method id:withdrawal-method class:form-control "Select payment method" "PayPal" "UPI"]
    </div>

    <div class="form-group payment-details" id="paypal-details" style="display: none;">
        <label for="paypal-email">PayPal Email *</label>
        [email* paypal-email id:paypal-email class:form-control placeholder "Enter your PayPal email"]
    </div>

    <div class="form-group payment-details" id="upi-details" style="display: none;">
        <label for="upi-id">UPI ID *</label>
        [text* upi-id id:upi-id class:form-control placeholder "Enter your UPI ID"]
    </div>

    <div class="form-submit">
        [submit class:submit-button "Submit Withdrawal Request"]
    </div>
</div>