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Simple online registration form / HTML and PHP

EASY and FAST WEB FORM PROJECT / Need completed by Friday April 22, 2011.

I need a simple online HTML/PHP registration form that will send a registration submission email to us and redirect the client to a thank you page. We want the ability to easily modify the registration form and thank you page later.

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FEATURES

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- Registration form

- Thank you page

- Approx. 10 form fields

- PHP processing with spam protection

- Antispam Captcha image protection box

- Emails registration information to owner

- After submission user is redirected to thank you page

- Easy to edit HTML and PHP code so we can alter later

- Text will be provided once project is accepted

- Winning bidder must provide free hosting of form

Registration Form Fields

Personal Information:

• First Name [Text field]

• Last Name [Text field]

• Address [Text field]

• City [Text field]

• State [Text field – Drop down menu]

• Postal/Zip Code [Text field]

• Email [Text field]

• Target Zip Codes [Text field]

• Home Phone [Text field]

• Cell Phone [Text field]

Users submit the form and the results are sent to an email address. Must be clean looking and 100% reliable

This should be a quick job for any decent developer. Possible future work.

Budget - $30

Additional Registration form field:

* What area of town do you service? North, South, East or West [Text Field]

- Visitor should be allowed to choose multiple areas of service, if desired.

Kỹ năng: HTML, Lập mã Photoshop, PHP, Thiết lập Bản thảo, Thiết kế trang web

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Về Bên Thuê:
( 20 nhận xét ) Houston, United States

Mã Dự Án: #1033352

Đã trao cho:

AdamsK

ready for service sir. thanks.

$30 USD trong 1 ngày
(68 Đánh Giá)
5.5

37 freelancer đang chào giá trung bình $30 cho công việc này

KESHAVINFOTECH

Please check pmb.

$30 USD trong 1 ngày
(588 Đánh Giá)
8.0
agilesols

please check your [url removed, login to view]

$30 USD trong 0 ngày
(218 Đánh Giá)
7.5
freeworks

Please check my PM

$30 USD trong 0 ngày
(215 Đánh Giá)
7.1
neelwt4u

Please check the pmb. With best regards

$30 USD trong 2 ngày
(152 Đánh Giá)
6.9
supportkumar

view INBOX for details.

$30 USD trong 1 ngày
(274 Đánh Giá)
6.9
webmediadesigner

WILL DO IT RIGHT AWAY, PLEASE REFER PMB FOR FURTHER DISCUSSION.

$30 USD trong 1 ngày
(99 Đánh Giá)
6.9
webzin

Lets get it done.. Thnx Webzin Team [url removed, login to view]

$30 USD trong 0 ngày
(80 Đánh Giá)
6.7
netdukesinc

Registration form with antispam Captcha image protection box. Developing using PHP. Online 18 hours everyday. Can start right away. Thanks!

$30 USD trong 0 ngày
(157 Đánh Giá)
6.5
ichurakov

Please check inbox. Thnx.

$30 USD trong 0 ngày
(247 Đánh Giá)
6.4
salientcomputer

Hi Please see PMB.

$30 USD trong 1 ngày
(172 Đánh Giá)
6.1
kirundeep11

Please check PMB.

$30 USD trong 1 ngày
(31 Đánh Giá)
5.6
synergydeveloper

Hi, Please check PMB

$30 USD trong 0 ngày
(7 Đánh Giá)
5.2
Softanz

Dear sir, After reading your project details,we are interested in this project and would like to bid on this project. Please view my PMB for more details. Thank you.

$30 USD trong 0 ngày
(24 Đánh Giá)
4.8
Marksimson

ready to start right now. Please read my private message.

$30 USD trong 1 ngày
(10 Đánh Giá)
4.8
sumannath

Please check PMB

$30 USD trong 0 ngày
(18 Đánh Giá)
4.4
cedricve

Hey sir, Kindly check my pm. Cedric

$30 USD trong 0 ngày
(17 Đánh Giá)
4.5
ecitius

Hi, My name is Mayank, a technical team leader from E-citius Infotech Pvt Ltd. I’m interested in the position of "Website Developer" you recently posted. During past 5 years we have designed, developed & manag Thêm

$30 USD trong 1 ngày
(3 Đánh Giá)
4.3
mdshahidjmi

Ready to complete this task as soon as possible

$30 USD trong 0 ngày
(9 Đánh Giá)
4.3
saasfreelancer

Please have a look at your inbox. Thanks, SAAS

$30 USD trong 1 ngày
(17 Đánh Giá)
4.2
tehnicsmart

Hello, view pm

$30 USD trong 0 ngày
(12 Đánh Giá)
3.7