Code: 👇

                <!-- HTML -->
                                        
                 <center>
                <div id="form" class="shariki-form-container js-enabled">
    <p class="ctr"> Pentru a comanda DiaFlex Forte, alegeți unul din cei trei
        baloane. În fiecare balon se ascunde o reducere la DiaFlex Forte: 25%, 35%
        sau 50%. În funcție de reducerea care vă va cădea, veți putea comanda
        DiaFlex Forte la acel preț. Aveți doar 1 încercare. </p>
    <div class="shariki__wrapper">
        <div class="shariki__title"></div>
        <div class="shariki__container">
            <div class="box__shariki">
                <div class="hi">
                    <p id="shariki__sales2" class="shariki__sales "></p>
                </div>
                <div id="shariki__2" class="shariki"> </div>
            </div>
            <div class="box__shariki">
                <div class="hi">
                    <p id="shariki__sales1" class="shariki__sales "></p>
                </div>
                <div id="shariki__1" class="shariki"></div>
            </div>
            <div class="box__shariki">
                <div class="hi">
                    <p id="shariki__sales3" class="shariki__sales "></p>
                </div>
                <div id="shariki__3" class="shariki"></div>
            </div>
        </div>
    </div>
    <div class="wheel-order-section">
        <div class="form-header">
            <p class="green-text">Pentru dvs. a fost rezervat DiaFlex Forte. Aveți 3
                minute pentru a lăsa o cerere.</p>
            <p class="green-text">Costul preparatului pentru dvs. va fi -- 159 RON
                în loc de <del>318 RON</del></p>
        </div>
        <div class="product-section">
            <figure class="Figure product"> <img src="../../img/elements/forms/form-6/product.webp"
                    class="prod_img">
                <div class="priceс"> <span class="discountс">Reducerea dvs.
                        personală -- 50%!</span> <s><span class="js_old_price price_old">318
                            RON</span></s> <b class="new_price js_new_price price_main">159 RON</b>
                </div>
            </figure>
        </div>
        <div class="form-body">
            <div class="deadline-text">
                <p>Pentru obținere indicați numele și numărul de telefon.</p>
                <p> A mai rămas timp:</p>
                <div class="timer"> <span class="time-remains" id="wheel-min">10</span> : <span
                        class="time-remains" id="wheel-sec">00</span> </div>
            </div>
            <form action="api/send.php" autocomplete="off" method="post">
                <div class="form-inputs"> <input type="text" name="fullName" maxlength="30"
                        placeholder="Introduceți Nume" required="required" value="">
                    <input type="tel" name="phoneNumber" placeholder="Introduceți Număr de telefon"
                        required="required" value="">
                </div>
                <button class="submit-button" type="submit">Trimite</button>

                <input type="hidden" name="country" value="PL" />
                <input type="hidden" name="language" value="pl" />
                <input type="hidden" name="offer_id" value="{offer_id}" />
                <input type="hidden" name="subid" value="{subid}" />
                <input type="hidden" name="offer_title" value="DiaFlex Forte" />
                <input type="hidden" name="niche" value="vision" />

            </form>
            <p class="footnote"> *Dacă nu completați formularul până la ora
                indicată, locul dumneavoastră va fi atribuit altei persoane,
                deoarece medicamentul va fi în lipsă. </p>
        </div>
    </div>
    <div class="spin-result-wrapper default_spin-result-wrapper">
        <div class="pop-up-window">
            <div class="close-popup"></div> <span class="pop-up-heading">Felicitări!</span>
            <p class="ruletka-p pop-up-text">Puteți comanda DiaFlex Forte cu o
                reducere de 50%!</p> <a class="pop-up-button" data-toggle="scroll" href="">ОК</a>
        </div>
    </div>
</div>
            </center>
               
                                        
                <!-- CSS -->
                       
#form {
    all          : initial;
    display      : block;
    box-sizing   : border-box;
    font-family  : system-ui, -apple-system, "Segoe UI", Arial, sans-serif;
    font-size    : 14px;
    line-height  : 1.4;
    color        : #111;
    max-width    : 650px;
    margin       : 30px auto;
    padding      : 20px;
}

#form *,
#form *::before,
#form *::after {
    box-sizing: border-box;
}

#form .shariki__wrapper .shariki__container {
    display: -webkit-box !important;
    display: -ms-flexbox !important;
    display: flex !important;
    -ms-flex-pack: distribute !important;
    justify-content: space-around !important;
}

#form .shariki__wrapper .box__shariki {
    -webkit-perspective: 500px !important;
    perspective: 500px !important;
    position: relative !important;
    width: 190px !important;
    height: 400px !important;
}

#form .shariki__wrapper .shariki {
    position: absolute !important;
    top: 0 !important;
    left: 0 !important;
    width: 100% !important;
    height: 100% !important;
    background-image: url("../../../img/elements/forms/form-6/shar1.webp") !important;
    background-repeat: no-repeat !important;
    background-size: 100% !important;
    cursor: pointer !important;
    animation: float 3s ease-in-out infinite;
}

#form .shariki__wrapper .hi {
    position: absolute !important;
    top: 0 !important;
    left: 0 !important;
    width: 100% !important;
    height: 100% !important;
}

#form .shariki__wrapper .shariki__sales {
    position: absolute !important;
    top: 30% !important;
    left: 60% !important;
    -webkit-transform: translate(-50%, -50%);
    transform: translate(-50%, -50%);
    font-size: 50px !important;
    line-height: 57px !important;
    font-weight: 700 !important;
    color: red !important;
    border-radius: 30px !important;
    padding: 30px 5px !important;
    width: 85% !important;
    min-width: 70px !important;
}

#form #shariki__2 {
    background-image: url("../../../img/elements/forms/form-6/shar2.webp") !important;
}

#form #shariki__3 {
    background-image: url("../../../img/elements/forms/form-6/shar3.webp") !important;
}

#form .shariki_img {
    display: block;
}

#form .ctr {
    text-align: center;
}

@keyframes balloonExplode {
  0% {
    transform: scale(1) rotate(0deg);
    opacity: 1;
  }
  60% {
    transform: scale(2.2) rotate(10deg);
    opacity: 1;
  }
  100% {
    transform: scale(2.5) rotate(20deg);
    opacity: 0;
  }
}

@keyframes float {
  0%   { transform: translate(0px, 0px) rotate(0deg); }
  25%  { transform: translate(2px, -10px) rotate(1deg); }
  50%  { transform: translate(0px, -15px) rotate(-1deg); }
  75%  { transform: translate(-2px, -10px) rotate(1deg); }
  100% { transform: translate(0px, 0px) rotate(0deg); }
}

#form .shariki.pop {
  animation: balloonExplode 1.2s ease-in-out forwards;
}

#form .shariki.hidden {
  display: none !important;
}

#form .wheel-order-section {
    display      : block;
    background   : #fff;
    border       : 2px solid #27ae60;
    border-radius: 10px;
    padding      : 30px;
    margin-top   : 20px;
}

#form.js-enabled .wheel-order-section {
    display: none;
}

#form.js-enabled .wheel-order-section.show {
    display  : block;
    animation: fadeInUp 0.6s ease-out;
}

#form .shariki__wrapper {
    display: none;
}

#form.js-enabled .shariki__wrapper {
    display: block;
}

#form .form-header {
    text-align   : center;
    margin-bottom: 30px;
}

#form .green-text {
    color      : #27ae60;
    font-size  : 18px;
    font-weight: bold;
    margin     : 10px 0;
}

#form .product-section {
    text-align   : center;
    margin-bottom: 30px;
}

#form .Figure.product {
    position  : relative;
    display   : inline-block;
    margin    : 0 auto;
    text-align: center;
}

#form .Figure.product img.prod_img,
#form .prod_img {
    max-width : 350px;
    max-height: 380px;
    object-fit: contain;
    display   : block;
    margin    : 0 auto;
}

#form .product {
    position: relative;
    display : inline-block;
}

#form .Figure.product .priceс,
#form .product .priceс {
    position         : absolute;
    background       : linear-gradient(135deg, #ffd700 0%, #ffb300 100%);
    padding          : 10px;
    border-radius    : 15px;
    transform        : rotate(-10deg);
    box-shadow       : 0 5px 15px rgba(0, 0, 0, 0.3);
    width            : 220px;
    text-align       : center;
    display          : flex;
    flex-wrap        : wrap;
    flex-direction   : column;
    bottom           : 0px;
    right             : 10px;
    -webkit-transform: rotate(-10deg);
    -moz-transform   : rotate(-10deg);
    -ms-transform    : rotate(-10deg);
    -o-transform     : rotate(-10deg);
    height: auto;
    line-height: 1.1;
}

#form .Figure.product .discountс,
#form .product .discountс {
    color      : #000;
    font-weight: bold;
    font-size  : 18px;
    margin     : 0 0 5px 0;
    display    : block;
}

#form .Figure.product .price_old,
#form .product .price_old {
    color          : #666;
    text-decoration: line-through;
    font-size      : 16px;
    margin         : 5px 0;
}

#form .Figure.product .price_main,
#form .product .price_main {
    color      : #000;
    font-size  : 28px;
    font-weight: bold;
    margin     : 5px 0 0 0;
    text-shadow: 1px 1px 2px rgba(255, 255, 255, 0.8);
    display: block;
    line-height: 0.7;
    border: none;
    text-decoration: underline;
    text-decoration-color: red;
}

#form .form-body {
    text-align: center;
}

#form .deadline-text {
    margin-bottom: 25px;
    font-size     : 16px;
    line-height   : 1.5;
}

#form .timer {
    font-size  : 24px;
    font-weight: bold;
    color      : #e74c3c;
    margin     : 10px 0;
}

#form .time-remains {
    background   : #e74c3c;
    color        : #fff;
    padding      : 5px 10px;
    border-radius: 5px;
    margin       : 0 2px;
}

#form .form-inputs {
    display: flex;
    flex-direction: column;
    align-items: center;
    gap: 10px;
    margin: 0 auto;
    margin-bottom: 20px;
    width: 450px;
    max-width: 100%;
}

#form .form-inputs input {
    all: initial;
    display: block;
    font-family: inherit;
    font-size: 16px;
    line-height: 1.2;
    width: 100%;
    padding: 12px;
    border: 2px solid #ddd;
    border-radius: 5px;
    text-align: left;
    box-sizing: border-box;
}

#form .form-inputs input:focus {
    outline     : none;
    border-color: #3498db;
}

#form .submit-button {
    all: initial;
    display: inline-block;
    font-family: inherit;
    font-size: 18px;
    line-height: 1.2;
    padding: 15px 40px;
    background: #e74c3c;
    color: #fff;
    border: none;
    border-radius: 5px;
    font-weight: bold;
    cursor: pointer;
    transition: background 0.3s;
    text-transform: uppercase;
    text-align: center;
    box-sizing: border-box;
    width: 450px;
    max-width: 100%;
}

#form .submit-button:hover {
    background: #c0392b;
}

#form .footnote {
    font-size  : 12px;
    color      : #7f8c8d;
    margin-top : 20px;
    line-height: 1.4;
}

#form .spin-result-wrapper {
    display: none;
    padding: 0 10px;
    -webkit-box-sizing: border-box;
    box-sizing: border-box;
    width: 100%;
    top: 0;
    z-index: 999;
    left: 0;
    height: 100%;
    position: fixed;
    background-color: transparent;
    text-align: center;
    align-items: center;
    justify-content: center;
    background-color: #00000085;
}

#form .spin-result-wrapper[style*="display: block"] {
    display: flex !important;
}

#form .close-popup {
    position: absolute;
    width: 30px;
    height: 30px;
    top: -40px;
    right: -20px;
    cursor: pointer;
    border-radius: 50%;
    background-color: rgba(255, 255, 255, 0.9);
    -webkit-box-shadow: 0 0 10px #fff;
    box-shadow: 0 0 10px #fff;
    display: flex;
    align-items: center;
    justify-content: center;
}

#form .close-popup::before,
#form .close-popup::after {
    content: "";
    position: absolute;
    width: 18px;
    height: 2px;
    background-color: #333;
    border-radius: 1px;
}

#form .close-popup::before {
    transform: rotate(45deg);
}

#form .close-popup::after {
    transform: rotate(-45deg);
}

#form .pop-up-heading {
    font-size: 24px;
    font-weight: bold;
    color: #27ae60;
    margin-bottom: 15px;
}

#form .pop-up-text {
    margin-top: 15px;
    margin-bottom: 25px;
    font-size: 18px;
    line-height: 1.4;
    color: #333;
    text-align: center !important;
    padding: 0 !important;
}

#form .pop-up-button {
    all: initial;
    display: inline-block;
    font-family: inherit;
    font-size: 18px;
    line-height: 1.2;
    padding: 12px 30px;
    background: #27ae60;
    color: rgb(255, 255, 255) !important;
    text-decoration: none !important;
    border-radius: 5px;
    font-weight: bold;
    transition: background 0.3s;
    cursor: pointer;
    text-transform: uppercase;
    text-align: center;
}

#form .pop-up-button:hover {
    background-color: #229954;
    color: rgb(255, 255, 255) !important;
    text-decoration: none !important;
}

#form .pop-up-window {
    position: relative;
    max-width: 400px;
    width: 90%;
    margin: 0px auto;
    background: #fff none repeat scroll 0% 0%;
    text-align: center;
    padding: 40px;
    padding-top: 70px;
    padding-bottom: 20px;
    border-radius: 15px;
    box-shadow: 0 10px 30px rgba(0, 0, 0, 0.3);
    -webkit-animation: 0.7s ease 0s normal none 1 running pop-up-appear;
    animation: 0.7s ease 0s normal none 1 running pop-up-appear;
    top: auto;
}

#form .pop-up-window::before {
    content: "";
    position: absolute;
    width: 110px;
    height: 110px;
    top: -55px;
    left: 0;
    right: 0px;
    margin: 0 auto;
    background-color: rgb(113, 195, 65);
    border-radius: 50%;
    -webkit-animation: 0.5s ease 0.6s normal backwards 1 running pop-up-appear-before;
    animation: 0.5s ease 0.6s normal backwards 1 running pop-up-appear-before;
}

#form .pop-up-window::after {
    content: "";
    position: absolute;
    width: 50px;
    height: 20px;
    top: -20px;
    left: 0px;
    right: 0;
    margin: 0 auto;
    border-width: medium medium 4px 4px;
    border-style: none none solid solid;
    border-color: currentcolor currentcolor rgb(255, 255, 255) rgb(255, 255, 255);
    -webkit-transform: rotate(-45deg);
    transform: rotate(-45deg);
    -webkit-transition: opacity 1s ease 0s;
    transition: opacity 1s ease 0s;
    -webkit-animation: 0.5s ease 0.6s normal backwards 1 running pop-up-appear-after;
    animation: 0.5s ease 0.6s normal backwards 1 running pop-up-appear-after;
}

@keyframes fadeInUp {
    from {
        opacity  : 0;
        transform: translateY(30px);
    }
    to {
        opacity  : 1;
        transform: translateY(0);
    }
}

@media (max-width: 768px) {
    #form {
        padding: 15px;
        margin: 20px auto;
    }
}

@media (max-width: 420px) {
    #form .shariki__wrapper .box__shariki,
    #form .shariki__wrapper .shariki {
        width: 85px !important;
        height: 163px !important;
    }
}


                 <!-- JS -->

               
<script>
document.addEventListener('DOMContentLoaded', () => {
  const discounts = [25, 35, 50];
  const ballons = [1, 2, 3].map((id, idx) => ({
    id,
    node: document.getElementById(`shariki__${id}`),
    salesNode: document.getElementById(`shariki__sales${id}`),
    discount: discounts[idx]
  }));
  const resultWrapper = document.querySelector('.spin-result-wrapper');
  const popUpHeading = document.querySelector('.pop-up-heading');
  const popUpText = document.querySelector('.pop-up-text');
  const priceOld = document.querySelector('.js_old_price');
  const priceMain = document.querySelector('.js_new_price');
  const priceDiscountLabel = document.querySelector('.discountс');
  const formHeaderTexts = document.querySelectorAll('.wheel-order-section .form-header .green-text');
  const wheelMin = document.getElementById('wheel-min');
  const wheelSec = document.getElementById('wheel-sec');
  const form = document.querySelector('.wheel-order-section form');
  const wheelSection = document.querySelector('.wheel-order-section');
  const sharikiWrapper = document.querySelector('.shariki__wrapper');

  if (wheelSection) {
    wheelSection.style.display = 'none';
  }

  const startSeconds = 10 * 60; 
  let remainingSec = startSeconds;
  let timerInterval;
  let choiceMade = false;

  function formatTime(sec) {
    const m = Math.floor(sec / 60); const s = sec % 60;
    return {m: String(m).padStart(2, '0'), s: String(s).padStart(2, '0')};
  }

  function updateTimer() {
    if (remainingSec <= 0) {
      clearInterval(timerInterval);
      wheelMin.textContent = '00';
      wheelSec.textContent = '00';
      form.querySelector('.submit-button').disabled = true;
      form.querySelector('.footnote').textContent = 'Timpul a expirat. Reîncărcați pagina pentru o nouă încercare.';
      return;
    }
    remainingSec -= 1;
    const t = formatTime(remainingSec);
    wheelMin.textContent = t.m;
    wheelSec.textContent = t.s;
  }

  timerInterval = setInterval(updateTimer, 1000);

  function applyDiscount(value) {
    const basePrice = parseInt((priceOld.textContent.match(/\d+/) || [318])[0], 10);
    const newPrice = Math.round(basePrice * (100 - value) / 100);
    priceMain.textContent = `${newPrice} RON`;
    priceDiscountLabel.textContent = `Reducerea dvs personală -- ${value}%!`;
    if (formHeaderTexts.length > 0) {
      formHeaderTexts[0].textContent = `Pentru dvs. a fost rezervat DiaFlex Forte. Aveți 3 minute pentru a lăsa o cerere.`;
      formHeaderTexts[1].textContent = `Costul preparatului pentru dvs. va fi -- ${newPrice} RON în loc de ${basePrice} RON`;
    }
    popUpHeading.textContent = 'Felicitări!';
    popUpText.textContent = `Ai câștigat ${value}% reducere. Prețul tău final este ${newPrice} RON.`;
    resultWrapper.style.display = 'flex';
  }

  function lockAllBallons() {
    ballons.forEach(({node}) => {
      if (node) {
        node.classList.add('disabled');
        node.style.pointerEvents = 'none';
      }
    });
  }

  ballons.forEach((balloon) => {
    if (!balloon.node || !balloon.salesNode) return;
    balloon.salesNode.textContent = `${balloon.discount}%`; 

    balloon.node.addEventListener('click', () => {
      if (choiceMade) return;
      choiceMade = true;

      const winDisc = 50;
      const otherDiscounts = [25, 35];
      const notSelected = ballons.filter((b) => b.id !== balloon.id);

      notSelected.forEach((b, idx) => {
        if (b.salesNode) {
          b.salesNode.textContent = `${otherDiscounts[idx]}%`;
        }
        if (b.node) {
          b.node.style.opacity = '0.5';
        }
      });

      if (balloon.salesNode) {
        balloon.salesNode.textContent = `${winDisc}%`;
      }
      if (balloon.node) {
        balloon.node.classList.add('active');
        balloon.node.style.border = '2px solid #ffd700';
      }

      lockAllBallons();
      applyDiscount(winDisc);

      window.setTimeout(() => {
        if (resultWrapper) {
          resultWrapper.classList.add('active');
          resultWrapper.style.display = 'flex';
        }
      }, 250);
    });
  });

  document.querySelectorAll('.close-popup, .pop-up-button').forEach(el => {
    el.addEventListener('click', (evt) => {
      if (resultWrapper) {
        resultWrapper.style.display = 'none';
        resultWrapper.classList.remove('active');
      }
      if (sharikiWrapper) {
        sharikiWrapper.style.display = 'none';
      }
      if (wheelSection) {
        wheelSection.style.display = 'block';
      }
      evt.preventDefault();
    });
  });

  form.addEventListener('submit', (evt) => {
    const name = form.querySelector('input[name="fullName"]').value.trim();
    const phone = form.querySelector('input[name="phoneNumber"]').value.trim();
    if (!name || !phone) {
      evt.preventDefault();
      alert('Vă rugăm completați corect numele și telefonul.');
      return;
    }
    if (remainingSec <= 0) {
      evt.preventDefault();
      alert('Timpul a expirat. Reîncărcați pagina.');
      return;
    }
  });
});
</script>