517314 Form Submit added to existing button link

IN PROGRESS
Bids
1
Avg Bid (USD)
$50
Project Budget (USD)
N/A

Project Description:
Our coupon website allows clients to post their coupons. When they create an online coupon in their admin page...the site generates a "button" which links back to the page which has their coupon. Our clients put this button on their web sites so visitors can click on it to view and print their coupon from our server.
We need to add a form submit to the generated code for the button.
We need Email, Full Name, Address, City, State, Zip, Phone.

View an example with one of our clients here:
www.westchestersmiledesign.com
Click on the yellow "Get discount coupon here" button on the top.
THis takes you to a page where you're required to fill out the form before continuing to the coupon page.
It also sends the date to our email.

Only here the submit page is built into our clients web site.
We Do NOt Need THis.

We need a botton that generates it's own form submit (perhaps with our logo from wheresthatcoupon.com on the top) then onto the coupon page


Here's the code from that build (you can also see using view source at www.westchestersmiledesign.com)

<div id="eMail"><p class="eMail">Email: <a href="mailto:info@caliandentistry.com">info@caliandentistry.com</a></p>
<p><a href="http://www.caliandentistry.com/coupons.php"><img alt="" src="http://www.wheresthatcoupon.com/images/webcoupon_button.jpg" height="33" width="88" border="0"> </a></p></div>
</div>

</div>




<p>Please fill the form to be taken to your free coupon print page.</p>

<script type="text/javascript" src="jquery.js"></script>
<script type="text/javascript" src="validator.js"></script>
<form action="mail.php" method="post" onsubmit="return validation();">
<table cellpadding="0" cellspacing="0" border="0" class="form">
<tr>
<td class="left"><strong>* Email: </strong></td>
<td><input type="text" class="text" name="email" id="email" /></td>
</tr>
<tr>
<td class="left"><strong>* Full Name:</strong> </td>
<td><input type="text" class="text" name="name" id="name" /></td>
</tr>
<tr>
<td class="left"><strong>* Mailing adress:</strong> </td>
<td><input type="text" class="text" name="address" id="address" /></td>
</tr>
<tr>
<td class="left"><strong>* City:</strong> </td>
<td><input type="text" class="text" name="city" id="city" /></td>
</tr>
<tr>
<td class="left"><strong>* State:</strong> </td>
<td><select name="state" id="state">
<option value="Select" selected="selected">Please select</option>
<option value="Alabama">Alabama</option>
<option value="Alaska">Alaska</option>
<option value="Arizona">Arizona</option>
<option value="Arkansas">Arkansas</option>
<option value="California">California</option>
<option value="Colorado">Colorado</option>
<option value="Connecticut">Connecticut</option>
<option value="Delaware">Delaware</option>
<option value="District Of Columbia">District Of Columbia</option>
<option value="Florida">Florida</option>
<option value="Georgia">Georgia</option>
<option value="Hawaii">Hawaii</option>
<option value="Idaho">Idaho</option>
<option value="Illinois">Illinois</option>
<option value="Indiana">Indiana</option>
<option value="Iowa">Iowa</option>
<option value="Kansas">Kansas</option>
<option value="Kentucky">Kentucky</option>
<option value="Louisiana">Louisiana</option>
<option value="Maine">Maine</option>
<option value="Maryland">Maryland</option>
<option value="Massachusetts">Massachusetts</option>
<option value="Michigan">Michigan</option>
<option value="Minnesota">Minnesota</option>
<option value="Mississippi">Mississippi</option>
<option value="Missouri">Missouri</option>
<option value="Montana">Montana</option>
<option value="Nebraska">Nebraska</option>
<option value="Nevada">Nevada</option>
<option value="Ohio">New Hampshire</option>
<option value="Ohio">New Jersey</option>
<option value="New Mexico">New Mexico</option>
<option value="New York">New York</option>
<option value="North Carolina">North Carolina</option>
<option value="North Dakota">North Dakota</option>
<option value="Ohio">Ohio</option>
<option value="Oklahoma">Oklahoma</option>
<option value="Oregon">Oregon</option>
<option value="Pennsylvania">Pennsylvania</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Rhode Island">Rhode Island</option>
<option value="South Carolina">South Carolina</option>
<option value="South Dakota">South Dakota</option>
<option value="Tennessee">Tennessee</option>
<option value="Texas">Texas</option>
<option value="Utah">Utah</option>
<option value="Vermont">Vermont</option>
<option value="Virginia">Virginia</option>
<option value="Washington">Washington</option>
<option value="West Virginia">West Virginia</option>
<option value="Wisconsin">Wisconsin</option>
<option value="Wyoming">Wyoming</option>
</select></td>
</tr>
<tr>
<td class="left"><strong>* Zip code: </strong></td>
<td><input type="text" class="text" name="zip" id="zip" /></td>
</tr>
<tr>
<td class="left"><strong>* Phone number:</strong> </td>
<td><input type="text" class="text" name="phone" id="phone" /></td>
</tr>
<tr>
<td class="left"><strong>* Verification code:</strong> </td>
<td><img src="antibot.php" alt="captcha" id="captcha" />
<input type="text" class="text" name="sec_code" id="sec_code" /></td>
</tr>
<tr>
<td class="left"> </td>
<td><input type="submit" class="submit" value="Submit" /></td>
</tr>
<tr>
<td class="left"><span>*</span> required field </td>
<td> </td>
</tr>
</table>
</form>

</div>
</div>
<div class="clear"></div>
</div>


We do not need the resulting form submit page to live on our clients site...but rather an middle page for the info submit then onto our link for them

Here's the original link that our site generates for a coupon:


<a target="_blank" href="http://www.wheresthatcoupon.com/cpncreate.cfm?couponid=243&location=223"><img alt="" src="http://www.wheresthatcoupon.com/images/webcoupon_button.jpg" height="33" width="88" border="0">

Our site is in COLD FUSION.


Now we need to add the submit form page to this code and placed on our site so any new or existing coupons built in the admin section will generate the link code for the button now with the submit page as well.

This should not take much time...1 day. This should not cost too much. Any bids awarded it is expressely understood that work done on our site is "work for Hire" status granting ownership to the work done to us.

We have many fixes and need for code changes on our sites...there plenty more to come.

We will give access to our files and site at www.wheresthatcoupon.com upon your bid being accepted.

Skills required:
Anything Goes, Graphic Design, HTML, Javascript, jQuery / Prototype, Link Building, Logo Design, PHP
About the employer:
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