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SImple contact form

I require a simple contact form for my webpage.

This is what needs to be captured and e-mailed..... (cloning form from : [url removed, login to view])

Name

E-mail address

Confirm E-mail address

Choose Department (Drop down menu and sends to appropriate e-mail address)

Products (Drop down menu)

Message details

SUBMIT button

CLEAR button

No captcha required

** NO FLASH ALLOWED **

Must work with Safari and Firefox browsers

Delivery within 1 day of winning bid

Full escrow payment will be done as soon as project is accepted

Kỹ năng: HTML, Java, Javascript, PHP, Thiết kế trang web

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Về Bên Thuê:
( 302 nhận xét ) Sydney, Australia

Mã Dự Án: #1023167

Đã trao cho:

J0re

I can get this done in less than a day. Please check PMB.

$30 USD trong 0 ngày
(7 Đánh Giá)
2.9

3 freelancer đang chào giá trung bình $43 cho công việc này

mhanif

Hi Jason . Please Check PM

$49 USD trong 1 ngày
(178 Đánh Giá)
6.6
Kamalkishover

Pls Check PM

$50 USD trong 1 ngày
(21 Đánh Giá)
4.4