diff --git a/frontend/src/components/features/onboarding/information-request-form.tsx b/frontend/src/components/features/onboarding/information-request-form.tsx
new file mode 100644
index 0000000000..099838cbfc
--- /dev/null
+++ b/frontend/src/components/features/onboarding/information-request-form.tsx
@@ -0,0 +1,139 @@
+import { useState } from "react";
+import { useTranslation } from "react-i18next";
+import { I18nKey } from "#/i18n/declaration";
+import { BrandButton } from "#/components/features/settings/brand-button";
+
+export type RequestType = "saas" | "self-hosted";
+
+interface InformationRequestFormProps {
+  requestType: RequestType;
+  onBack: () => void;
+}
+
+export function InformationRequestForm({
+  requestType,
+  onBack,
+}: InformationRequestFormProps) {
+  const { t } = useTranslation();
+  const [formData, setFormData] = useState({
+    name: "",
+    email: "",
+    company: "",
+    message: "",
+  });
+
+  const handleInputChange = (
+    e: React.ChangeEvent<HTMLInputElement | HTMLTextAreaElement>,
+  ) => {
+    const { name, value } = e.target;
+    setFormData((prev) => ({ ...prev, [name]: value }));
+  };
+
+  const handleSubmit = (e: React.FormEvent) => {
+    e.preventDefault();
+    // TODO: Implement form submission
+    console.log("Form submitted:", { requestType, ...formData });
+  };
+
+  const title =
+    requestType === "saas"
+      ? t(I18nKey.ENTERPRISE$SAAS_TITLE)
+      : t(I18nKey.ENTERPRISE$SELF_HOSTED_TITLE);
+
+  return (
+    <div
+      data-testid="information-request-form"
+      className="w-full max-w-md flex flex-col gap-6"
+    >
+      <div className="text-center">
+        <h2 className="text-xl font-semibold text-white">{title}</h2>
+        <p className="text-[#8C8C8C] mt-2">
+          {t(I18nKey.ENTERPRISE$FORM_SUBTITLE)}
+        </p>
+      </div>
+
+      <form onSubmit={handleSubmit} className="flex flex-col gap-4">
+        <div className="flex flex-col gap-2">
+          <label htmlFor="name" className="text-sm text-white">
+            {t(I18nKey.ENTERPRISE$FORM_NAME_LABEL)}
+          </label>
+          <input
+            type="text"
+            id="name"
+            name="name"
+            value={formData.name}
+            onChange={handleInputChange}
+            required
+            className="px-4 py-2.5 bg-[#0D0D0D] border border-[#242424] rounded-sm text-white placeholder-[#8C8C8C] focus:outline-none focus:border-[#404040]"
+            placeholder={t(I18nKey.ENTERPRISE$FORM_NAME_PLACEHOLDER)}
+          />
+        </div>
+
+        <div className="flex flex-col gap-2">
+          <label htmlFor="email" className="text-sm text-white">
+            {t(I18nKey.ENTERPRISE$FORM_EMAIL_LABEL)}
+          </label>
+          <input
+            type="email"
+            id="email"
+            name="email"
+            value={formData.email}
+            onChange={handleInputChange}
+            required
+            className="px-4 py-2.5 bg-[#0D0D0D] border border-[#242424] rounded-sm text-white placeholder-[#8C8C8C] focus:outline-none focus:border-[#404040]"
+            placeholder={t(I18nKey.ENTERPRISE$FORM_EMAIL_PLACEHOLDER)}
+          />
+        </div>
+
+        <div className="flex flex-col gap-2">
+          <label htmlFor="company" className="text-sm text-white">
+            {t(I18nKey.ENTERPRISE$FORM_COMPANY_LABEL)}
+          </label>
+          <input
+            type="text"
+            id="company"
+            name="company"
+            value={formData.company}
+            onChange={handleInputChange}
+            required
+            className="px-4 py-2.5 bg-[#0D0D0D] border border-[#242424] rounded-sm text-white placeholder-[#8C8C8C] focus:outline-none focus:border-[#404040]"
+            placeholder={t(I18nKey.ENTERPRISE$FORM_COMPANY_PLACEHOLDER)}
+          />
+        </div>
+
+        <div className="flex flex-col gap-2">
+          <label htmlFor="message" className="text-sm text-white">
+            {t(I18nKey.ENTERPRISE$FORM_MESSAGE_LABEL)}
+          </label>
+          <textarea
+            id="message"
+            name="message"
+            value={formData.message}
+            onChange={handleInputChange}
+            rows={4}
+            className="px-4 py-2.5 bg-[#0D0D0D] border border-[#242424] rounded-sm text-white placeholder-[#8C8C8C] focus:outline-none focus:border-[#404040] resize-none"
+            placeholder={t(I18nKey.ENTERPRISE$FORM_MESSAGE_PLACEHOLDER)}
+          />
+        </div>
+
+        <div className="flex flex-col gap-3 mt-4">
+          <BrandButton
+            type="submit"
+            variant="primary"
+            className="w-full px-6 py-2.5"
+          >
+            {t(I18nKey.ENTERPRISE$FORM_SUBMIT)}
+          </BrandButton>
+          <BrandButton
+            type="button"
+            variant="secondary"
+            onClick={onBack}
+            className="w-full px-6 py-2.5 bg-[#050505] text-white border border-[#242424] hover:bg-white hover:text-black"
+          >
+            {t(I18nKey.COMMON$BACK)}
+          </BrandButton>
+        </div>
+      </form>
+    </div>
+  );
+}
diff --git a/frontend/src/i18n/declaration.ts b/frontend/src/i18n/declaration.ts
index d93d339456..680070c60f 100644
--- a/frontend/src/i18n/declaration.ts
+++ b/frontend/src/i18n/declaration.ts
@@ -1204,5 +1204,15 @@ export enum I18nKey {
   ENTERPRISE$SELF_HOSTED_FEATURE_DATA_CONTROL = "ENTERPRISE$SELF_HOSTED_FEATURE_DATA_CONTROL",
   ENTERPRISE$SELF_HOSTED_FEATURE_COMPLIANCE = "ENTERPRISE$SELF_HOSTED_FEATURE_COMPLIANCE",
   ENTERPRISE$SELF_HOSTED_FEATURE_SUPPORT = "ENTERPRISE$SELF_HOSTED_FEATURE_SUPPORT",
+  ENTERPRISE$FORM_SUBTITLE = "ENTERPRISE$FORM_SUBTITLE",
+  ENTERPRISE$FORM_NAME_LABEL = "ENTERPRISE$FORM_NAME_LABEL",
+  ENTERPRISE$FORM_NAME_PLACEHOLDER = "ENTERPRISE$FORM_NAME_PLACEHOLDER",
+  ENTERPRISE$FORM_EMAIL_LABEL = "ENTERPRISE$FORM_EMAIL_LABEL",
+  ENTERPRISE$FORM_EMAIL_PLACEHOLDER = "ENTERPRISE$FORM_EMAIL_PLACEHOLDER",
+  ENTERPRISE$FORM_COMPANY_LABEL = "ENTERPRISE$FORM_COMPANY_LABEL",
+  ENTERPRISE$FORM_COMPANY_PLACEHOLDER = "ENTERPRISE$FORM_COMPANY_PLACEHOLDER",
+  ENTERPRISE$FORM_MESSAGE_LABEL = "ENTERPRISE$FORM_MESSAGE_LABEL",
+  ENTERPRISE$FORM_MESSAGE_PLACEHOLDER = "ENTERPRISE$FORM_MESSAGE_PLACEHOLDER",
+  ENTERPRISE$FORM_SUBMIT = "ENTERPRISE$FORM_SUBMIT",
   COMMON$BACK = "COMMON$BACK",
 }
diff --git a/frontend/src/i18n/translation.json b/frontend/src/i18n/translation.json
index 2789cfc62a..6f7175678f 100644
--- a/frontend/src/i18n/translation.json
+++ b/frontend/src/i18n/translation.json
@@ -20473,6 +20473,176 @@
     "tr": "Özel destek seçenekleri",
     "uk": "Виділені варіанти підтримки"
   },
+  "ENTERPRISE$FORM_SUBTITLE": {
+    "en": "Fill out the form below and we'll get back to you shortly.",
+    "ja": "以下のフォームにご記入ください。すぐにご連絡いたします。",
+    "zh-CN": "请填写以下表格，我们会尽快与您联系。",
+    "zh-TW": "請填寫以下表格，我們會盡快與您聯繫。",
+    "ko-KR": "아래 양식을 작성해 주시면 곧 연락드리겠습니다.",
+    "no": "Fyll ut skjemaet nedenfor, så tar vi kontakt snart.",
+    "ar": "املأ النموذج أدناه وسنتواصل معك قريبًا.",
+    "de": "Füllen Sie das Formular aus und wir melden uns in Kürze.",
+    "fr": "Remplissez le formulaire ci-dessous et nous vous recontacterons rapidement.",
+    "it": "Compila il modulo qui sotto e ti ricontatteremo presto.",
+    "pt": "Preencha o formulário abaixo e entraremos em contato em breve.",
+    "es": "Complete el formulario a continuación y nos pondremos en contacto pronto.",
+    "ca": "Ompliu el formulari a continuació i us contactarem aviat.",
+    "tr": "Aşağıdaki formu doldurun, en kısa sürede size geri döneceğiz.",
+    "uk": "Заповніть форму нижче, і ми зв'яжемося з вами найближчим часом."
+  },
+  "ENTERPRISE$FORM_NAME_LABEL": {
+    "en": "Name",
+    "ja": "名前",
+    "zh-CN": "姓名",
+    "zh-TW": "姓名",
+    "ko-KR": "이름",
+    "no": "Navn",
+    "ar": "الاسم",
+    "de": "Name",
+    "fr": "Nom",
+    "it": "Nome",
+    "pt": "Nome",
+    "es": "Nombre",
+    "ca": "Nom",
+    "tr": "Ad",
+    "uk": "Ім'я"
+  },
+  "ENTERPRISE$FORM_NAME_PLACEHOLDER": {
+    "en": "Enter your name",
+    "ja": "名前を入力してください",
+    "zh-CN": "请输入您的姓名",
+    "zh-TW": "請輸入您的姓名",
+    "ko-KR": "이름을 입력하세요",
+    "no": "Skriv inn navnet ditt",
+    "ar": "أدخل اسمك",
+    "de": "Geben Sie Ihren Namen ein",
+    "fr": "Entrez votre nom",
+    "it": "Inserisci il tuo nome",
+    "pt": "Digite seu nome",
+    "es": "Ingrese su nombre",
+    "ca": "Introduïu el vostre nom",
+    "tr": "Adınızı girin",
+    "uk": "Введіть своє ім'я"
+  },
+  "ENTERPRISE$FORM_EMAIL_LABEL": {
+    "en": "Work Email",
+    "ja": "仕事用メールアドレス",
+    "zh-CN": "工作邮箱",
+    "zh-TW": "工作電子郵件",
+    "ko-KR": "업무용 이메일",
+    "no": "Jobb-e-post",
+    "ar": "البريد الإلكتروني للعمل",
+    "de": "Geschäftliche E-Mail",
+    "fr": "E-mail professionnel",
+    "it": "Email di lavoro",
+    "pt": "E-mail corporativo",
+    "es": "Correo electrónico de trabajo",
+    "ca": "Correu electrònic de treball",
+    "tr": "İş E-postası",
+    "uk": "Робоча електронна пошта"
+  },
+  "ENTERPRISE$FORM_EMAIL_PLACEHOLDER": {
+    "en": "you@company.com",
+    "ja": "you@company.com",
+    "zh-CN": "you@company.com",
+    "zh-TW": "you@company.com",
+    "ko-KR": "you@company.com",
+    "no": "you@company.com",
+    "ar": "you@company.com",
+    "de": "you@company.com",
+    "fr": "vous@entreprise.com",
+    "it": "tu@azienda.com",
+    "pt": "voce@empresa.com",
+    "es": "tu@empresa.com",
+    "ca": "tu@empresa.com",
+    "tr": "sen@sirket.com",
+    "uk": "ви@компанія.com"
+  },
+  "ENTERPRISE$FORM_COMPANY_LABEL": {
+    "en": "Company",
+    "ja": "会社名",
+    "zh-CN": "公司",
+    "zh-TW": "公司",
+    "ko-KR": "회사",
+    "no": "Selskap",
+    "ar": "الشركة",
+    "de": "Unternehmen",
+    "fr": "Entreprise",
+    "it": "Azienda",
+    "pt": "Empresa",
+    "es": "Empresa",
+    "ca": "Empresa",
+    "tr": "Şirket",
+    "uk": "Компанія"
+  },
+  "ENTERPRISE$FORM_COMPANY_PLACEHOLDER": {
+    "en": "Enter your company name",
+    "ja": "会社名を入力してください",
+    "zh-CN": "请输入您的公司名称",
+    "zh-TW": "請輸入您的公司名稱",
+    "ko-KR": "회사명을 입력하세요",
+    "no": "Skriv inn selskapets navn",
+    "ar": "أدخل اسم شركتك",
+    "de": "Geben Sie Ihren Firmennamen ein",
+    "fr": "Entrez le nom de votre entreprise",
+    "it": "Inserisci il nome della tua azienda",
+    "pt": "Digite o nome da sua empresa",
+    "es": "Ingrese el nombre de su empresa",
+    "ca": "Introduïu el nom de la vostra empresa",
+    "tr": "Şirket adınızı girin",
+    "uk": "Введіть назву вашої компанії"
+  },
+  "ENTERPRISE$FORM_MESSAGE_LABEL": {
+    "en": "Message (optional)",
+    "ja": "メッセージ（任意）",
+    "zh-CN": "留言（可选）",
+    "zh-TW": "留言（可選）",
+    "ko-KR": "메시지 (선택사항)",
+    "no": "Melding (valgfritt)",
+    "ar": "الرسالة (اختياري)",
+    "de": "Nachricht (optional)",
+    "fr": "Message (facultatif)",
+    "it": "Messaggio (opzionale)",
+    "pt": "Mensagem (opcional)",
+    "es": "Mensaje (opcional)",
+    "ca": "Missatge (opcional)",
+    "tr": "Mesaj (isteğe bağlı)",
+    "uk": "Повідомлення (необов'язково)"
+  },
+  "ENTERPRISE$FORM_MESSAGE_PLACEHOLDER": {
+    "en": "Tell us about your needs...",
+    "ja": "ご要望をお聞かせください...",
+    "zh-CN": "告诉我们您的需求...",
+    "zh-TW": "告訴我們您的需求...",
+    "ko-KR": "귀하의 요구 사항을 알려주세요...",
+    "no": "Fortell oss om dine behov...",
+    "ar": "أخبرنا عن احتياجاتك...",
+    "de": "Erzählen Sie uns von Ihren Anforderungen...",
+    "fr": "Parlez-nous de vos besoins...",
+    "it": "Raccontaci le tue esigenze...",
+    "pt": "Conte-nos sobre suas necessidades...",
+    "es": "Cuéntenos sobre sus necesidades...",
+    "ca": "Expliqueu-nos les vostres necessitats...",
+    "tr": "Bize ihtiyaçlarınızı anlatın...",
+    "uk": "Розкажіть нам про ваші потреби..."
+  },
+  "ENTERPRISE$FORM_SUBMIT": {
+    "en": "Submit",
+    "ja": "送信",
+    "zh-CN": "提交",
+    "zh-TW": "提交",
+    "ko-KR": "제출",
+    "no": "Send inn",
+    "ar": "إرسال",
+    "de": "Absenden",
+    "fr": "Envoyer",
+    "it": "Invia",
+    "pt": "Enviar",
+    "es": "Enviar",
+    "ca": "Enviar",
+    "tr": "Gönder",
+    "uk": "Надіслати"
+  },
   "COMMON$BACK": {
     "en": "Back",
     "ja": "戻る",
diff --git a/frontend/src/routes/information-request.tsx b/frontend/src/routes/information-request.tsx
index 7a801be403..e172ca0620 100644
--- a/frontend/src/routes/information-request.tsx
+++ b/frontend/src/routes/information-request.tsx
@@ -1,9 +1,14 @@
+import { useState } from "react";
 import { useTranslation } from "react-i18next";
 import { useNavigate } from "react-router";
 import { I18nKey } from "#/i18n/declaration";
 import { Card } from "#/ui/card";
 import { Text } from "#/ui/typography";
 import { BrandButton } from "#/components/features/settings/brand-button";
+import {
+  InformationRequestForm,
+  RequestType,
+} from "#/components/features/onboarding/information-request-form";
 import OpenHandsLogoWhite from "#/assets/branding/openhands-logo-white.svg?react";
 import CloudIcon from "#/icons/cloud.svg?react";
 import StackedIcon from "#/icons/stacked.svg?react";
@@ -30,7 +35,7 @@ interface EnterpriseCardProps {
   title: string;
   description: string;
   features: string[];
-  learnMoreHref: string;
+  onLearnMore: () => void;
   learnMoreLabel: string;
 }
 
@@ -39,7 +44,7 @@ function EnterpriseCard({
   title,
   description,
   features,
-  learnMoreHref,
+  onLearnMore,
   learnMoreLabel,
 }: EnterpriseCardProps) {
   return (
@@ -48,26 +53,33 @@ function EnterpriseCard({
       <h3 className="text-lg font-semibold text-white">{title}</h3>
       <Text className="text-[#8C8C8C]">{description}</Text>
       <FeatureList features={features} />
-      <a
-        href={learnMoreHref}
-        target="_blank"
-        rel="noopener noreferrer"
+      <button
+        type="button"
+        onClick={onLearnMore}
         className="mt-2 w-fit px-6 py-2.5 text-sm rounded-sm bg-[#050505] text-white border border-[#242424] hover:bg-white hover:text-black transition-colors"
       >
         {learnMoreLabel}
-      </a>
+      </button>
     </Card>
   );
 }
 
-const ENTERPRISE_URL = "https://openhands.dev/enterprise/";
-
 export default function InformationRequest() {
   const { t } = useTranslation();
   const navigate = useNavigate();
+  const [selectedRequestType, setSelectedRequestType] =
+    useState<RequestType | null>(null);
 
   const handleBack = () => {
-    navigate(-1);
+    navigate("/login");
+  };
+
+  const handleLearnMore = (type: RequestType) => {
+    setSelectedRequestType(type);
+  };
+
+  const handleFormBack = () => {
+    setSelectedRequestType(null);
   };
 
   const saasFeatures = [
@@ -84,6 +96,22 @@ export default function InformationRequest() {
     t(I18nKey.ENTERPRISE$SELF_HOSTED_FEATURE_SUPPORT),
   ];
 
+  // Show form if a request type is selected
+  if (selectedRequestType) {
+    return (
+      <div
+        data-testid="information-request-page"
+        className="w-full max-w-4xl flex flex-col items-center gap-8 p-6"
+      >
+        <OpenHandsLogoWhite width={55} height={55} />
+        <InformationRequestForm
+          requestType={selectedRequestType}
+          onBack={handleFormBack}
+        />
+      </div>
+    );
+  }
+
   return (
     <div
       data-testid="information-request-page"
@@ -109,7 +137,7 @@ export default function InformationRequest() {
           title={t(I18nKey.ENTERPRISE$SAAS_TITLE)}
           description={t(I18nKey.ENTERPRISE$SAAS_DESCRIPTION)}
           features={saasFeatures}
-          learnMoreHref={ENTERPRISE_URL}
+          onLearnMore={() => handleLearnMore("saas")}
           learnMoreLabel={t(I18nKey.ENTERPRISE$LEARN_MORE)}
         />
         <EnterpriseCard
@@ -117,7 +145,7 @@ export default function InformationRequest() {
           title={t(I18nKey.ENTERPRISE$SELF_HOSTED_TITLE)}
           description={t(I18nKey.ENTERPRISE$SELF_HOSTED_DESCRIPTION)}
           features={selfHostedFeatures}
-          learnMoreHref={ENTERPRISE_URL}
+          onLearnMore={() => handleLearnMore("self-hosted")}
           learnMoreLabel={t(I18nKey.ENTERPRISE$LEARN_MORE)}
         />
       </div>