diff --git a/app/routes/rpserver_.application.tsx b/app/routes/rpserver_.application.tsx
new file mode 100644
index 0000000..1e7a55c
--- /dev/null
+++ b/app/routes/rpserver_.application.tsx
@@ -0,0 +1,88 @@
+import {
+  Button,
+  Container,
+  FormControl,
+  FormLabel,
+  Heading,
+  Input,
+  NumberDecrementStepper,
+  NumberIncrementStepper,
+  NumberInput,
+  NumberInputField,
+  NumberInputStepper,
+  Textarea,
+  VStack,
+} from "@chakra-ui/react";
+import { useLoaderData } from "@remix-run/react";
+
+export async function loader({ context }: { context: RequestContext }) {
+  const { current_user: user } = context.data;
+
+  if (!user.id)
+    throw new Response(null, {
+      status: 401,
+    });
+
+  if (await context.env.DATA.get(`rpserverblock_${user.id}`))
+    throw new Response(null, {
+      status: 403,
+    });
+
+  return null;
+}
+
+export default function () {
+  useLoaderData<typeof loader>();
+
+  return (
+    <Container maxW="container.md">
+      <Heading pb="32px">RP Server Application</Heading>
+      <VStack alignItems="start" spacing={12}>
+        <FormControl isRequired>
+          <FormLabel>Server Invite</FormLabel>
+          <Input maxLength={48} placeholder="https://discord.gg/abcdef123456" />
+        </FormControl>
+        <FormControl isRequired>
+          <FormLabel>Roblox Username</FormLabel>
+          <Input maxLength={20} placeholder="builderman" />
+        </FormControl>
+        <FormControl isRequired>
+          <FormLabel>How old are you?</FormLabel>
+          <NumberInput>
+            <NumberInputField />
+            <NumberInputStepper>
+              <NumberIncrementStepper />
+              <NumberDecrementStepper />
+            </NumberInputStepper>
+          </NumberInput>
+        </FormControl>
+        <FormControl isRequired>
+          <FormLabel>Introduce yourself!</FormLabel>
+          <Textarea
+            placeholder="Who are you? What do you enjoy doing? Write everything you want us to know about you."
+            rows={5}
+          />
+        </FormControl>
+        <FormControl isRequired>
+          <FormLabel>What is your RP server about?</FormLabel>
+          <Input
+            maxLength={256}
+            placeholder="This can be just about anything tangentally related to CC2."
+          />
+        </FormControl>
+        <FormControl>
+          <FormLabel>Explain the above in more details</FormLabel>
+          <Textarea
+            placeholder="What are your specific plans for your server?"
+            rows={5}
+          />
+        </FormControl>
+        <FormControl>
+          <FormLabel>Anything else?</FormLabel>
+          <Textarea placeholder="Any questions or comments" rows={5} />
+        </FormControl>
+        <Button>Submit</Button>
+      </VStack>
+    </Container>
+  );
+}