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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...

To add to this project...

Create a similar looking log in form, for username and password

Create a similar looking payment form with the following fields:
Full Name on Credit Card
Credit Card Number --> an image to the right of the input box with small credit icons of visa & mastercard
Credit Card Expiration Date
CVV/CVC Code --> a little pop up hint to show an image of where that is on the credit card
Address on file for Credit Card, which includes, address, city, state, zip code

These 3 forms should all look similar and very appealing and web 2.0ish

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

Xem nhiều hơn: samples of my work, online web work, online php form builder with database, what w, what is a w-9 form, w-9 what is it, w-9, online w-9, copy of w-9, 9 w, Web Elements, web 2, online web page builder, make my web, form builder, enter captcha, javascript table copy, online page builder, web page builder, javascript form copy

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

ID dự án: #1048745

Được 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 [login to view URL],Bryce

$75 USD trong 2 ngày
(207 Nhận xét)
7.8
SoftSandila

hi i can help, thanx, adnan

$60 USD trong 3 ngày
(60 Nhận xét)
6.4
cristisst

Please read Pm for more details.

$80 USD trong 1 ngày
(107 Nhận xét)
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 Nhận xét)
0.0
CreativesolsUK

Looking forward to start the work Thanks

$45 USD trong 1 ngày
(0 Nhận xét)
0.5