Create Custom Web Form for my New Website

Completed Posted Apr 22, 2013 Paid on delivery
Completed Paid on delivery

I am in the process of designing a new website that requires a basic web form on each page. The form should work from my web server, hosted by [url removed, login to view], which runs PHP 5.3. I can provide additional information about my server as needed. Pixel sizes can also be provided if required. Please see the attached image for the form content. All form data should be sent to an email address.

CSS Electronic Forms HTML Website Design

Project ID: #4453249

About the project

16 proposals Remote project Active Apr 22, 2013

Awarded to:

Infenixwebs

Hi, I have experience in PHP projects, please check your inbox, thanks.

$84 USD in 1 day
(115 Reviews)
6.6

16 freelancers are bidding on average $93 for this job

ranganalx

Hi, good day! Let me do this. I'm available and is perfectly fit for this. Hoping to hear from you. Thanks!

$154 USD in 3 days
(109 Reviews)
6.0
Eswar87

Hi, This can be done within hours after you allot me the project. Please check PM for more details. Regards, Eswar.

$53 USD in 1 day
(24 Reviews)
5.4
pankajknj

I can complete this form within one hour and can start right now.

$35 USD in 1 day
(41 Reviews)
5.1
dzmitrij

Hello, Can make this work. Regards. Dima

$34 USD in 2 days
(14 Reviews)
4.4
praveen458

I am a javascript and php programmer.I can do this job,please look at my message thanks,praveen

$35 USD in 2 days
(6 Reviews)
3.5
magfixcorp

I can help you

$50 USD in 1 day
(1 Review)
2.9
rafsan2007zannat

Lets go beyond ...

$50 USD in 0 days
(7 Reviews)
2.6
deepakc147

Hello. Interesting proposition. I'm ready to work.

$210 USD in 2 days
(2 Reviews)
2.6
itSoftProjects

ready to start work. Easy task for me. please check PMB.

$110 USD in 2 days
(3 Reviews)
1.8
eliaa

i have 3 year experience in web development and design using php,mysql,html,css,jquery.<br>i'm ready to start asap.

$66 USD in 1 day
(2 Reviews)
1.4
loftyideas

I have gone through your project requirements and must say we will like to work on your project. Please check you PMB.

$45 USD in 3 days
(0 Reviews)
0.0
shopnobaaaj

Let's go together...

$36 USD in 0 days
(0 Reviews)
0.0
AtlantaWebDesign

Ready to add your form online.

$148 USD in 3 days
(0 Reviews)
0.0