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Make my form look web 2.0 appealing w/captcha

I need someone to recreate my form to make it very visually appealing, web 2.0ish...

I have attached a picture of what it currently looks like, then also a picture of something I tried with an online web form builder, but ultimately, did not work...

I have also attached a copy of the form page...

Please have a couple samples of your work that you can show to me...

The most important thing is that the form elements must keep their current names so that I can enter that data into the database table...

Kỹ năng: AJAX, CSS, HTML5, Javascript, PHP

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Về Bên Thuê:
( 9 nhận xét ) Pevely, United States

Mã Dự Án: #1048745

Đã trao cho:

ecartsolutions

Jquery UI expert Can start on it right away and get it done in a few hours. Please check message board for details

$50 USD trong 0 ngày
(269 Đánh Giá)
6.4

6 freelancer đang chào giá trung bình $58 cho công việc này

brycep

Hi,Let's get it done.Thanks,Bryce

$75 USD trong 2 ngày
(207 Đánh Giá)
7.8
SoftSandila

hi i can help, thanx, adnan

$60 USD trong 3 ngày
(60 Đánh Giá)
6.4
cristisst

Please read Pm for more details.

$80 USD trong 1 ngày
(107 Đánh Giá)
6.2
khu84

I have enough professional experience (4+ years) to do it right and deliver high quality work.

$35 USD trong 2 ngày
(0 Đánh Giá)
0.0
CreativesolsUK

Looking forward to start the work Thanks

$45 USD trong 1 ngày
(0 Đánh Giá)
0.5