Nex-Form - need a few things fixed and added

Job ID: 34321496

Budget: $30 – $250 USD

Please view our form here:
https://gulfcoastcleaningservice.com/contact-us/
Click "request quote" this is the form we need updated.

Attached are 5 pictures.

Slides 3, 12 and 18.

Slide 3 it shows "Fort Walton Beach, FL" need this changed to "Pensacola, FL"

Slide 12 the selections are not centered would like these centered on the screen.

Slide 18 you can see the 3 fields "please re-enter...." only one should pop up when that selection is made. (When selecting email it asks to reconfirm email etc)

Picture of the current final screen and the new mockup what we would like the final screen to look like.

Also as you can see the x at the top right to close the popup is not all the way in the screen if this can be moved to over a bit so it fits correctly.

Please let me know if you have any questions would love to have this complete asap!