Urgent PHP-mysql form programming

Avg Bid (USD)
Project Budget (USD)
$30 - $250

Project Description:
1.Urgent Contact us form - programming
simply show confirmation and client side validation
and send all requests to an email we will give you
and confirmation email to user and online message

Urgent Submit Flat Pay request programming

with Db insert and Db CMS login to show all requests with admin login and ability to change admin and pass in the interface
with basic show all of all records by order date Descending
and ability to change status from pending to Active by CMS admin
and also you need to send emails to user and admin when there is a new record insert

this is php/mysql and we will give you access and u create the Requests table for now

we need to program all fields and validation based on what optional or not
and i need to see all CMS
+ Validation
also when in DB also an email to send to admin and user for the request made with confirmation

also You need to make sure after user register in this form when he click the login button on home page
he will have a username and password login and when he enter he can submit the same request without requiring him to enter all his info(provider)
info again and just the actual request info with patient info


program this for all states
CA selection will show different set of documents we will give you

You need to add all states and program the next page selection based on state selection CA or all others

after this project you will program a new registration form
in a new project

Skills required:
About the employer:
Public Clarification Board
Bids are hidden by the project creator. Log in as the employer to view bids or to bid on this project.
You will not be able to bid on this project if you are not qualified in one of the job categories. To see your qualifications click here.

$ 200
in 2 days
$ 250
in 2 days
$ 140
in 5 days
Hire webi1
$ 180
in 7 days
$ 250
in 3 days
$ 120
in 3 days
Hire orgglobe
$ 100
in 1 days
Hire ronzohan
$ 120
in 8 days