Split contact form with neon CTA

Summary

Professional contact form modal with a split layout: left panel showcases an agent's headshot bio in neon yellow, right panel collects visitor details across six form fields and service-interest checkboxes, linked by a boldly colored submit button.

Visual description

A modal dialog sits centered on a dark gray background. The form is split into two equal sections with glass-like transparency. The left side features a neon-yellow background with a circular portrait photo, contact buttons, and copy positioning the agent as "Project Coordinator." The right side has a darker gray background with white headings, three input fields (Your Name, E-mail, Phone), a message textarea, and a multi-select toggle grid offering service options (UI/UX Design, Website, Brand Identity, Content Production, Illustration, Other). A large neon-yellow "Submit" button anchors the bottom right. The header includes navigation (About, Services, Projects, Blog, Contact) and an X close button. Typography is clean sans-serif throughout, with white text on dark and dark text on yellow, ensuring high contrast.

Key takeaway

The neon-yellow accent creates visual pop and actionability without overwhelming the neutral palette. The split bio/form layout humanizes the contact experience by leading with a team member. The toggle-based service selection is more engaging than a dropdown. Glass transparency on the modal creates depth against the background.

Reuse notes

Strong for agency, consulting, or service-business contact flows. The split layout works best on desktop; may need adaptation for mobile. The neon yellow is particularly effective for creative or design-focused brands; substitute with brand primary for corporate contexts. Portrait and bio details should match actual team member. Useful pattern for appointment booking, demo requests, or qualified-lead capture forms.