This is a re-post to correct past error.
NOTE.: Some freelancers bid very low, many are novice. Bid what you feel your skills are worth. The work will go to the more skilled freelancer, not necessarily the lowest bid.
Write a form's code in html, so that upon output data is merged into pro forms html templates.
Details and a working example of what is needed is at one of my sites, start here - a-set-of-instructions.html at www.fox20085 in /folder formsBH --- that is:- http://www.fox200855.com/formsBH1/a-set-of-instructions.html. Please do NOT contact me via that site, only reply via this site - I will not deal with anyone directly.
This work is quite simple for anyone conversant with html, php and pearl type scripts. I have had such forms written before, and I guess the work is 2 hours - too 4 hours.
There will certainly be follow up work over the next three (3) months to improve the form as I start to use it, such as, e.g. make merged html template data output link to a word-press input form, automatically on click button by a form box lodge words inside box with google maps, take the url from the google maps result, encode the words with that url, so that a box can be clicked and the google maps code appears, which replaces a manual step. However, for the moment, only quote for thew basic work via a-set-of-instructions.html, but you must be willing to do 10 - 20 hours more work over a few months as needed - price to be agreed.