Make Contact Form With cool upload photo and all data to dat

IN PROGRESS
Bids
18
Avg Bid (USD)
$44
Project Budget (USD)
$30 - $250

Project Description:
I need a good contact form for my web page:
must be safe

The fields to include are:

Name
address
Email
Phone
comment
Query ( check fields)
Anti-spam Captcha box

Users submit the form and the results are sent to an email address. Must be clean looking and 100% reliable

This should be a quick job for any decent developer. Possible future work.

Budget - $30

Skills required:
jQuery / Prototype, MySQL, PHP, Website Design, XML
Additional Files: emailform.pdf
About the employer:
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