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diff --git a/components/request-form.tsx b/components/request-form.tsx
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+"use client";
+
+import { useState } from "react";
+import { Button } from "@/components/ui/button";
+import { Input } from "@/components/ui/input";
+import { Label } from "@/components/ui/label";
+import { Textarea } from "@/components/ui/textarea";
+
+const consumerDomains = [
+  "gmail.com",
+  "yahoo.com",
+  "hotmail.com",
+  "outlook.com",
+  "icloud.com",
+  "aol.com",
+  "proton.me",
+  "protonmail.com",
+];
+
+type Status = "idle" | "loading" | "success" | "error";
+
+export function RequestForm() {
+  const [status, setStatus] = useState<Status>("idle");
+  const [error, setError] = useState("");
+
+  async function onSubmit(e: React.FormEvent<HTMLFormElement>) {
+    e.preventDefault();
+    setError("");
+    const form = e.currentTarget;
+    const data = new FormData(form);
+    const name = String(data.get("name") || "").trim();
+    const email = String(data.get("email") || "").trim();
+    const company = String(data.get("company") || "").trim();
+    const role = String(data.get("role") || "").trim();
+    const outcomes = String(data.get("outcomes") || "").trim();
+
+    if (!name || !email || !company || !role || !outcomes) {
+      setStatus("error");
+      setError("Every field is required. Alignment begins with completeness.");
+      return;
+    }
+
+    const domain = email.split("@")[1]?.toLowerCase();
+    if (!domain || !email.includes("@")) {
+      setStatus("error");
+      setError("Please provide an institutional email.");
+      return;
+    }
+    if (consumerDomains.includes(domain)) {
+      setStatus("error");
+      setError(
+        "Consumer inboxes cannot attest PPoE. Please use your institutional email."
+      );
+      return;
+    }
+
+    setStatus("loading");
+    await new Promise((r) => setTimeout(r, 900));
+    setStatus("success");
+  }
+
+  if (status === "success") {
+    return (
+      <div className="rounded-3xl border border-fuchsia-400/30 bg-gradient-to-br from-violet-500/20 to-cyan-500/10 p-8">
+        <p className="font-mono text-[11px] uppercase tracking-[0.2em] text-primary">
+          Request received
+        </p>
+        <h2 className="mt-3 font-heading text-3xl text-foreground">
+          An outcomes partner will be in touch.
+        </h2>
+        <p className="mt-3 text-sm leading-relaxed text-muted-foreground">
+          Fit is a mutual decision. If your operating thesis, your lake, and
+          our fabric are prepared to compound, we will schedule a working
+          session — not a demo.
+        </p>
+      </div>
+    );
+  }
+
+  return (
+    <form onSubmit={onSubmit} className="space-y-5" noValidate>
+      <Field id="name" label="Full name" autoComplete="name" />
+      <Field
+        id="email"
+        label="Institutional email"
+        type="email"
+        autoComplete="email"
+      />
+      <Field id="company" label="Institution" autoComplete="organization" />
+      <Field id="role" label="Role" placeholder="Chief Transformation Officer" />
+      <div className="space-y-2">
+        <Label htmlFor="outcomes">
+          What outcomes are you looking to operationalize?
+        </Label>
+        <Textarea
+          id="outcomes"
+          name="outcomes"
+          rows={5}
+          className="min-h-28 text-sm"
+          placeholder="Be specific about the thesis, not the tools. The fabric will meet you there."
+        />
+      </div>
+      {status === "error" && error ? (
+        <p className="text-sm text-destructive" role="alert">
+          {error}
+        </p>
+      ) : null}
+      <Button
+        type="submit"
+        disabled={status === "loading"}
+        className="h-11 w-full px-5 sm:w-auto"
+      >
+        {status === "loading" ? "Attesting request…" : "Request access"}
+      </Button>
+    </form>
+  );
+}
+
+function Field({
+  id,
+  label,
+  type = "text",
+  autoComplete,
+  placeholder,
+}: {
+  id: string;
+  label: string;
+  type?: string;
+  autoComplete?: string;
+  placeholder?: string;
+}) {
+  return (
+    <div className="space-y-2">
+      <Label htmlFor={id}>{label}</Label>
+      <Input
+        id={id}
+        name={id}
+        type={type}
+        autoComplete={autoComplete}
+        placeholder={placeholder}
+        className="h-10"
+      />
+    </div>
+  );
+}