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161386 Web Form needed

Need a spam proof web form that will input to a database table you will create with the following information and will also send the information to multiple email addresses:

Form name "Defective"

Fields

Name, Address, City, State, Phone, Date and Message box for the users text input.

Then it must send input to 2 separate email addresses and the database.

This is very easy and straight forward and should take very little time to complete.

Fast payment for finished work as usual.

Kỹ năng: Bất kì công việc gì, PHP, Thiết kế trang web

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Mã Dự Án: #1907575