diff --git a/index.html b/index.html
index 58e2b54..54c3a5b 100644
--- a/index.html
+++ b/index.html
@@ -2655,32 +2655,6 @@
                 </p>
                 <form id="trial-form" novalidate>
                     <div class="modal-grid">
-                        <div class="modal-field-group">
-                            <label class="field-label" for="modal-company"
-                                >Company</label
-                            >
-                            <input
-                                type="text"
-                                id="modal-company"
-                                name="company"
-                                class="modal-field"
-                                placeholder="Company name"
-                                required
-                            />
-                        </div>
-                        <div class="modal-field-group">
-                            <label class="field-label" for="modal-name"
-                                >Full Name</label
-                            >
-                            <input
-                                type="text"
-                                id="modal-name"
-                                name="name"
-                                class="modal-field"
-                                placeholder="Jane Smith"
-                                required
-                            />
-                        </div>
                         <div class="modal-field-group full">
                             <label class="field-label" for="modal-email"
                                 >Work Email</label
@@ -2694,60 +2668,8 @@
                                 required
                             />
                         </div>
-                        <div class="modal-field-group full">
-                            <label class="field-label" for="modal-street"
-                                >Street Address</label
-                            >
-                            <input
-                                type="text"
-                                id="modal-street"
-                                name="street"
-                                class="modal-field"
-                                placeholder="Street and number"
-                                required
-                            />
-                        </div>
-                        <div class="modal-field-group">
-                            <label class="field-label" for="modal-postal"
-                                >Postal Code</label
-                            >
-                            <input
-                                type="text"
-                                id="modal-postal"
-                                name="postal_code"
-                                class="modal-field"
-                                placeholder="Postal code"
-                                required
-                            />
-                        </div>
-                        <div class="modal-field-group">
-                            <label class="field-label" for="modal-city"
-                                >City</label
-                            >
-                            <input
-                                type="text"
-                                id="modal-city"
-                                name="city"
-                                class="modal-field"
-                                placeholder="City"
-                                required
-                            />
-                        </div>
-                        <div class="modal-field-group">
-                            <label class="field-label" for="modal-country"
-                                >Country</label
-                            >
-                            <input
-                                type="text"
-                                id="modal-country"
-                                name="country"
-                                class="modal-field"
-                                placeholder="Country"
-                                required
-                            />
-                        </div>
                         <div
-                            class="modal-field-group modal-select"
+                            class="modal-field-group full modal-select"
                             id="modal-location-select"
                         >
                             <label class="field-label" for="modal-location"