Cancel Case - Done

<div class="modal-background">
    <div class="modal-container _48">
        <div class="modal-heading-container">
            <h1 class="modal-h1">Cancel Support Case</h1>
            <div class="model-icon w-embed">
                <svg xmlns="http://www.w3.org/2000/svg" height="512" width="512" fill="currentColor" viewbox="0 0 512 512"><path d="M34.5 420.4c-1.6 2.8-2.5 6-2.5 9.3c0 10.2 8.2 18.4 18.4 18.4l411.2 0c10.2 0 18.4-8.2 18.4-18.4c0-3.3-.9-6.4-2.5-9.3L276.5 75.8C272.2 68.5 264.4 64 256 64s-16.2 4.5-20.5 11.8L34.5 420.4zM6.9 404.2l201-344.6C217.9 42.5 236.2 32 256 32s38.1 10.5 48.1 27.6l201 344.6c4.5 7.7 6.9 16.5 6.9 25.4c0 27.8-22.6 50.4-50.4 50.4L50.4 480C22.6 480 0 457.4 0 429.6c0-8.9 2.4-17.7 6.9-25.4zM256 160c8.8 0 16 7.2 16 16l0 128c0 8.8-7.2 16-16 16s-16-7.2-16-16l0-128c0-8.8 7.2-16 16-16zM232 384a24 24 0 1 1 48 0 24 24 0 1 1 -48 0z"></path></svg>
            </div>
            <div>Are you sure you want to cancel this support case? This action cannot be undone.</div>
            <div class="space-1rem"></div>
        </div>
        <div class="auth-form w-form">
            <form id="new-case" name="new-case" data-name="new-case" method="post" class="form">
                <div class="form-field-container">
                    <div class="field-label-container">
                        <label for="name" class="field-label">Are You Sure?</label>
                        <div class="required-star">*</div>
                    </div>
                    <div data-delay="0" data-hover="false" class="dropdown w-dropdown">
                        <div class="dropdown-closed w-dropdown-toggle">
                            <div class="dropdown-arrow w-icon-dropdown-toggle"></div>
                            <div class="dropdown-text">Select one...</div>
                        </div>
                        <div class="dropdown-open w-dropdown-list">
                            <div class="dropdown-options">
                                <a href="#" class="dropdown-option no-selected w-inline-block">
                                    <div class="dropdown-option-text">Yes, cancel my case</div>
                                </a>
                                <a href="#" class="dropdown-option no-selected w-inline-block">
                                    <div class="dropdown-option-text">No, keep case open</div>
                                </a>
                            </div>
                        </div>
                    </div>
                </div>
                <div class="form-field-container">
                    <div class="field-label-container">
                        <label for="name" class="field-label">Reason</label>
                        <div class="required-star">*</div>
                    </div>
                    <textarea id="Close-Reason" name="Close-Reason" maxlength="5000" data-name="Close Reason" placeholder="Describe why you are cancelling this case..." class="form-field text-area w-input"></textarea>
                    <div class="text-area-under">
                        <div>639 / 2500</div>
                    </div>
                </div>
                <div class="form-button-container">
                    <input type="submit" data-wait="Please wait..." class="button full tertiary w-button" value="Go Back">
                    <input type="submit" data-wait="Please wait..." class="button full danger disabled w-button" value="Confirm Cancellation">
                </div>
            </form>
        </div>
        <div class="modal-close-button w-embed">
            <svg xmlns="http://www.w3.org/2000/svg" width="256" height="256" viewbox="0 0 24 24" fill="none" stroke="currentColor" stroke-width="2" stroke-linecap="round" stroke-linejoin="round"><line x1="18" y1="6" x2="6" y2="18"></line><line x1="6" y1="6" x2="18" y2="18"></line></svg>
        </div>
    </div>
</div>