Quick Custom design Php contact form

IN PROGRESS
Bids
14
Avg Bid (USD)
$8 / hr
Project Budget (USD)
$2 - $10 / hr

Project Description:
Quick custom look contact form,

Simple, Secure Contact form
(i dont mind if you want to base it off fast secure contact form or make it from scratch)

ADDITIONAL FIELDS NEEDED..
NAME
HOME NUMBER
MOBILE NUMBER
EMAIL ADDRESS
WEDDING VENUE
DATE OF WEDDING
QUESTION
+CAPTCHA
Please see attached file for the design idea to be used.

THIS MUST WORK WITH THE CURRENT THEME
I can give you access to the base template / theme, with navigation etc..
You just need to add the form as shown. With thank you message

EASY JOB FOR THOSE WHO KNOW HOW
Please note, i am aware of exactly what is involved to complete this task,
i just do not have the time to do it.. Ideally i would like this completed within 24-48hrs of accepting

Would like to find somebody who i could possible send small jobs like this to in the future for an ongoing working relationship

PLEASE READ ABOVE TO INSURE YOU UNDERSTAND MY NEEDS, AND BE ABLE TO WORK ASAP

Hours of work: Unspecified Project Duration: < 1 week Skills required:
CSS, HTML, PHP
Additional Files: 1212.jpg
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