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Contact Form

I need a simple small module of code i can insert into my website which will gather details from a client who is requesting a callback and send the data which has been input by the user to another server for processing. Please note, i can insert the code into the website myself so i just need the actual code to insert.

The fields i need to collect are

Title

First name

Last name

Telephone number

Email address

This is a snippet i got from the provider which explains what i need to place in my website.

You can also send form data straight to the software through the url to prevent multiple data entry for the client. The fields it accepts are 'title', 'forename', 'surname' and 'contact'. There are also fields 'd1', 'd2', 'd3' which can be used as generic fields to send extra data to the operator. Also include the variable cc=client code and ch=id code

For example:

[url removed, login to view]

I am also looking for someone who can possibly provide a regular service helping out with simple bits and bobs as i manage a growing number of websites.

Kỹ năng: HTML, PHP, Kiến trúc phần mềm

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Về Bên Thuê:
( 16 nhận xét ) Sale, United Kingdom

Mã Dự Án: #1066862

19 freelancer đang chào giá trung bình $34 cho công việc này

dagdya99

Lets start

$30 USD trong 1 ngày
(219 Đánh Giá)
7.1
rajawi9999

please check PM

$30 USD trong 0 ngày
(146 Đánh Giá)
6.5
phpevolution

Hi, will make bid more clear in private bid

$30 USD trong 1 ngày
(8 Đánh Giá)
5.5
norlink

Dear Sir/Madam, Please review Private Message Board for details. Thanks & Regards, Norlink

$31 USD trong 1 ngày
(9 Đánh Giá)
4.2
actiwe

Hello, please check a PM

$30 USD trong 0 ngày
(9 Đánh Giá)
3.9
tehnicsmart

Hello, view pm

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

Can do this right now and can code everything you want extra.

$30 USD trong 1 ngày
(1 Đánh Giá)
3.6
MCumic10

Hello, please check PM!

$30 USD trong 0 ngày
(1 Đánh Giá)
1.7
AtishayGoyal

Pls chk PMB.

$30 USD trong 1 ngày
(2 Đánh Giá)
1.6
SkipperRi

Respect, Experienced developer is ready to realize your project. For more details, please PM.

$30 USD trong 1 ngày
(1 Đánh Giá)
1.0
towhidjp

if u give me i try to best .

$35 USD trong 1 ngày
(0 Đánh Giá)
0.0
espyjer

I am ready start working on this project. I have understood the instructions given. hope you will give me a chance..

$30 USD trong 3 ngày
(0 Đánh Giá)
0.0
RLancer

i can do it definitely for you with accuracy and excellency...

$35 USD trong 1 ngày
(0 Đánh Giá)
0.0
SaphiraWeb

I can do it fast,if u know to put code on your website.

$30 USD trong 1 ngày
(0 Đánh Giá)
0.0
hgranpura

you will get the complete solution. tell me the full detail of the project.

$30 USD trong 1 ngày
(0 Đánh Giá)
0.0
creatiwittymedia

we are ready to start. please choose us we wont let you down.

$100 USD trong 1 ngày
(0 Đánh Giá)
0.0
SyedAsimshah

hi see PM..

$30 USD trong 1 ngày
(1 Đánh Giá)
0.0
smbakhtiar

I am [url removed, login to view] check PM.

$30 USD trong 0 ngày
(0 Đánh Giá)
0.0
makebee

Sir, Please see PM for details

$30 USD trong 30 ngày
(0 Đánh Giá)
0.0