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124425 Lead Capture System

I need a system to capture customer information for my users.

My users would be given a site in this fashion: [url removed, login to view]

A visitor would land on this page and then be asked to enter data in 3 steps.

Step1: name and email... CLICK to step 2

(I do this so if they abandon the process I will still capture names and email)

Step2: Additional data input... CLICK to step 3

Step3: a few check boxes and final SUBMIT

I then want this data emailed to the user in 1 email (not 3 separate emails) that is easy to read and understand OR I want them to receive an email notification that the form was submitted and direct them to a simple backend where they could login in and retrieve this data.

I would need to be able to integrate this into my design which is rather simple. My page is a 600px wide table with some images and some flash audio.

I need this rather quickly.

Kỹ năng: Bất kì công việc gì, Nhập liệu, Java, MySQL, PHP, Thiết kế trang web

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Mã Dự Án: #1870591