Need a simple CSS form creating with PHP validation

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

Project Description:
I need a form creating for my website that will ask user for his/her details, and address etc.

I have a example of a form which I would like a replica of styling wise.

All validation should be done via PHP not javascript, so checking fields are not empty and only contain the type of values they should do.

1 input of the form should be controlled by a slider, so you must be competent to do that.

Skills required:
Hire Dale369
Project posted by:
Dale369 United Kingdom
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.