Surehits web form integration

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Bids
12
Avg Bid (USD)
$180
Project Budget (USD)
$30 - $250

Project Description:
This is a very small project, I have a website created with wordpress, I need to integrate a (submit zip) form with surehits. Also the form should validate if the zip code is a valid us zip code or not. Sample of this job can be found on: mortgagelifeinsuranceonline.com, I already have the form as psd, you just need to create it as html and link it with the surehits code and also add the validation javascript code.
I will pay $30 for this small job.
Only developer with surehits experience are welcomed.

Skills required:
Javascript, PHP, Wordpress
About the employer:
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