I require a php script and a form for a website that has been created

IN PROGRESS
Bids
20
Avg Bid (AUD)
$106
Project Budget (AUD)
$30 - $250

Project Description:
Hi,

I require a HTML form to be created for a page on a website, that asks for the following information with mandatory fields attached to these fields so users can enter their information before a php script to email the contents to an email address in a cvs file. The email that is sent will need to contain the information from the data entered in the form and will need to be created as well.

The information on the form needs to include the following fields for data to be entered under the heading Personal Details:
Name - free form text field
Address - free form text field
Address 2- free form text field
City- free form text field
Post Code - 4 digit field
State - drop down options of NSW, QLD, VIC, ACT, NT, WA, TAS, International

I also need the following under the heading Optional Extras:
- Jersey Tribute - A tick box option for this one and if selected a tally will start, this item is $10
- Bib and brace cycling knicks - A tick box option for this one and if selected a tally will start, this item is $90. Also if this is selected a drop down box will need be there to advise what size. The size field needs to be a drop down option with the options s,m,l,xl,xxl,xxxl,xxxxl
- Standard cycling knicks - A tick box option for this one and if selected a tally will start, this item is $80. Also if this is selected a drop down box will need be there to advise what size. The size field needs to be a drop down option with the options s,m,l,xl,xxl,xxxl,xxxxl
- Vest - A tick box option for this one and if selected a tally will start, this item is $65. Also if this is selected a drop down box will need be there to advise what size. The size field needs to be a drop down option with the options s,m,l,xl,xxl,xxxl,xxxxl
- fleece are warmers - A tick box option for this one and if selected a tally will start, this item is $30. Also if this is selected a drop down box will need be there to advise what size. The size field needs to be a drop down option with the options s,m,l,xl
- Fleece knee warmers - A tick box option for this one and if selected a tally will start, this item is $35. Also if this is selected a drop down box will need be there to advise what size. The size field needs to be a drop down option with the options s,m,l,xl
- fleece leg warmers - A tick box option for this one and if selected a tally will start, this item is $40. Also if this is selected a drop down box will need be there to advise what size. The size field needs to be a drop down option with the options s,m,l,xl,
- return bus from Canberra - A tick box option for this one and if selected a tally will start, this item is $30.
- Friday partner accommodation, dinner and Saturday breakfast in Goulburn - A tick box option for this one and if selected a tally will start, this item is $110.
- Saturday night presentation dinner - A tick box option for this one and if selected a tally will start, this item is $40.
- Saturday night partner accommodation - A tick box option for this one and if selected a tally will start, this item is $60

Form code needs to be in html and can be easily edited if required by myself. I will own the code after the work and I can provide current website as well

All the fields above need to be sent in an email to an email address which I can provide

Thanks

Matt

Skills required:
PHP, Website Design
About the employer:
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