PHP payment form

Avg Bid (GBP)
Project Budget (GBP)
£20 - £250

Project Description:
Hi, I need to create a simple form to allow my customers to choose how they would like to be paid.

I would like users to be able to choose from a pull down menu the payment method. Once selected a form is shown for that particular payment method. When the form loads it should automatically switch to the current payment method.

The payment methods are...

1. Check
Name to print on check.
Address line 1
Address line 2
Address line 3
Address line 4

2. Check sent via Fedex
Same form fields required as check.

3. Payoneer
No form fields required just a save button.

4. Direct deposit
Name of account holder
Bank name
Routing number
Bank account number

5. International wire
name of account holder
Bank name
BIC number

The form needs to be checked for valid data. Check all required fields contain data and it is in an appropriate format. I will take care of the css, design and mysql integration. I just need the basic form layout, css/javascript to make the form work and the php file to verify the data.

Skills required:
Electronic Forms, Javascript, MySQL, PHP, Software Architecture
About the employer:
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