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diff --git a/src/widgets/DistributionForm/modal/types.ts b/src/widgets/DistributionForm/modal/types.ts
new file mode 100644
index 00000000..353b1d2e
--- /dev/null
+++ b/src/widgets/DistributionForm/modal/types.ts
@@ -0,0 +1,3 @@
+export interface IDistributionForm {
+ subscription: string
+}
diff --git a/src/widgets/DistributionForm/ui/DistributionForm.module.scss b/src/widgets/DistributionForm/ui/DistributionForm.module.scss
new file mode 100644
index 00000000..d47e9702
--- /dev/null
+++ b/src/widgets/DistributionForm/ui/DistributionForm.module.scss
@@ -0,0 +1,39 @@
+@use '@/shared/styles/utils/variables' as var;
+@use '@/shared/styles/utils/mixins' as media;
+
+.form {
+ display: flex;
+ flex-direction: column;
+ width: 100%;
+ padding: 20px 30px;
+ background: var.$white;
+ border-radius: 10px;
+ height: 230px;
+
+ @include media.respond-to('small') {
+ height: 290px;
+ }
+
+ &__title {
+ margin-bottom: 10px;
+ }
+
+ &__list {
+ display: flex;
+ column-gap: 20px;
+ margin-bottom: 30px;
+ }
+
+ &__buttons {
+ display: flex;
+ column-gap: 20px;
+ flex-direction: row;
+ width: 70%;
+
+ @include media.respond-to('small') {
+ flex-direction: column;
+ row-gap: 10px;
+ }
+ }
+}
+
diff --git a/src/widgets/DistributionForm/ui/DistributionForm.stories.tsx b/src/widgets/DistributionForm/ui/DistributionForm.stories.tsx
new file mode 100644
index 00000000..36d8cf6d
--- /dev/null
+++ b/src/widgets/DistributionForm/ui/DistributionForm.stories.tsx
@@ -0,0 +1,17 @@
+import { Meta, StoryObj } from '@storybook/react'
+
+import DistributionForm from './DistributionForm'
+
+const meta = {
+ title: 'widgets/DistributionForm',
+ component: DistributionForm,
+ parameters: {
+ layout: 'centered'
+ },
+ tags: ['autodocs']
+} satisfies Meta
+
+export default meta
+type Story = StoryObj
+
+export const Default: Story = {}
diff --git a/src/widgets/DistributionForm/ui/DistributionForm.tsx b/src/widgets/DistributionForm/ui/DistributionForm.tsx
new file mode 100644
index 00000000..aa6844b5
--- /dev/null
+++ b/src/widgets/DistributionForm/ui/DistributionForm.tsx
@@ -0,0 +1,87 @@
+import { Form, Formik } from 'formik'
+import { useNavigate } from 'react-router'
+
+import { Routes } from '@/shared/config/routerConfig/routes'
+import { Button, ButtonDesign, ButtonSize, ButtonTheme } from '@/shared/ui/Button/Button'
+import Checkbox from '@/shared/ui/Checkbox/Checkbox'
+import Heading, { HeadingType } from '@/shared/ui/Heading/Heading'
+import Label from '@/shared/ui/Label/Label'
+
+import { IDistributionForm } from '../modal/types'
+
+import styles from './DistributionForm.module.scss'
+
+const initialValues: IDistributionForm = {
+ subscription: String('Нет')
+}
+
+const subscription = [
+ { label: 'Да', value: 'Да' },
+ { label: 'Нет', value: 'Нет' }
+]
+
+const DistributionForm = () => {
+ const navigate = useNavigate()
+ function handleRedirectPrevious() {
+ navigate(Routes.ACCOUNT)
+ }
+ function handleRedirectNext() {
+ navigate(Routes.ACCOUNT)
+ }
+
+ return (
+ {
+ setSubmitting(false)
+ resetForm()
+ }}>
+ {({ isSubmitting }) => (
+
+ )}
+
+ )
+}
+export default DistributionForm