I need a database form on my site

I need a form on my website - I call prospects on the phone, qualify them then pass them along to a debt company I'm working with. 1. I want to fill out a one-page form on a web page as I'm qualifying the prospect. I have a list of the data fields - standard stuff - name, address, phone, email etc. 2. I forward the call to my client - a debt settlement company. The call is answered by one of his debt counselors. 3. I tell the debt counselor: "This is Mike Banks. I have Mary Smith on the line. Mary's phone number is 215-345-5442" 4. The debt counselor enters the phone number on a page which takes him to the form I filled out. I have a detailed overview. Please get in touch and I'll email it to you. Be sure and include your phone number please. Thanks Michael Banks e: mbanks@[url removed, login to view] v: 805-569-2678

## Deliverables

I'd like the coder to be U.S. based only. Thanks Michael mbanks@[url removed, login to view]

Kĩ năng: Kĩ thuật, MySQL, PHP, Quản lí dự án, Kiến trúc phần mềm, Kiểm tra phần mềm, Web Hosting, Quản lý website, Thử nghiệm trang web

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