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I am looking for functionality similar to the booking form here http://www.justjunk.com where users input their zip code and is then redirected to the corresponding page where they can choose the times they want the service done. Really, I am looking for something very similar to the booking form on http://www.justjunk.com.
I can do the styling, I just need the skeleton.
This will be integrated on a WordPress website, if that matters.