Create a questionnaire form in html5

IN PROGRESS
Bids
5
Avg Bid (USD)
$29 / hr
Project Budget (USD)
$15 - $25 / hr

Project Description:
Your mission if you choose to accept it will be to create a customized contact form and adding it to an existing html based webpage.

Ideally this would accomplished using this, which I already own : http://codecanyon.net/item/html-5-ajax-contact-form/122299?sso?WT.ac=category_item&WT.seg_1=category_item&WT.z_author=jigowatt

The contact form will include

2 hidden fields that will be populated by data passed from an aweber based opt-in page for users names and email addresses

2 drop down fields asking users what style of house they are looking for and how many bedrooms they need

Lastly 3 text fields

I need to be able to dictate which email addresses the form will be sent to when its filled out and when the form is completed you will create a quick tutorial either through screen recorded video or with screen shot images how I can add or change questions and email addresses the form is sent to.

Thank you!

Please write the word Apple in your bid description so I know you've read the project details entirely.

I need to assign this project quickly..

Hours of work: Unspecified Project Duration: < 1 week Skills required:
Electronic Forms, HTML, HTML5
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