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Hosting Site - Simple Form

I have a hosting site at [url removed, login to view] which has got new servers and design.

I want someone to implement a form on the order hosting page that does the following:

1) Has fields for

Name:(text field)

Username: (text field)

Password: (text field)

Plan: (drop down box)

Paypal Email: (text field)

Contact Email: (text field)

And submits the above form information to my email and then continues to PayPal send payment.

Anyone who can implement a payment process to my site (secure) without PayPal would be preferred !

Please note this site has just started up so bid's will be chosen as lowest and best.

Thank you

Kỹ năng: Lập trình C, Perl, PHP, An ninh Web, Thiết kế trang web

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Về Bên Thuê:
( 38 nhận xét ) Wakefield, United Kingdom

Mã Dự Án: #10262

11 freelancer đang chào giá trung bình $50 cho công việc này

netdevbiz

Please View PMB.

$20 USD trong 1 ngày
(144 Đánh Giá)
8.1
sakshiinfosys

Ready to start.

$50 USD trong 1 ngày
(26 Đánh Giá)
6.4
dabr

I am the owner of a web hosting company so I know how this works. It'll be easy, contact me!

$30 USD trong 1 ngày
(3 Đánh Giá)
4.5
CEGRAPHIX

We can do a standard form for you...no prob...using paypal and small admin panel for management....

$20 USD trong 1 ngày
(11 Đánh Giá)
4.1
jamesmarchant

This is not too hard. I have stated 3 days but this is maximum. I have much experience and can sort you out with a professional looking enquiry page. Let me know if you still need help Thanks James Marchant

$50 USD trong 3 ngày
(1 Đánh Giá)
3.3
maartenvr

See what I did on the DVD order page for www.braidsbybreslin.com. I can customize that to add your details....

$60 USD trong 2 ngày
(1 Đánh Giá)
0.0
AdminCentral

Please check Private Message Board. Thank you.

$20 USD trong 1 ngày
(0 Đánh Giá)
0.0
bid2

we can do it.

$100 USD trong 5 ngày
(0 Đánh Giá)
0.0
vedag

Hello, I am working as a sr manager with a product company having 13 yrs of exp. I am freelance developer too. Just completed a back-end implementation for PayPal for selling our products (downloadable in e-form) on Thêm

$80 USD trong 5 ngày
(0 Đánh Giá)
0.0
ijack

Hello will take only one to make it and only one hour to upload on your server , i have 80% work complete , so contact regards jack

$20 USD trong 1 ngày
(0 Đánh Giá)
0.0
sommet

we have already done these kind of things.Please check the link::www.mihiranet.com:: regards ::Sommet Gr Team::

$100 USD trong 1 ngày
(0 Đánh Giá)
3.9