Create online form on wordpress

IN PROGRESS
Bids
62
Avg Bid (USD)
$82
Project Budget (USD)
$30 - $250

Project Description:
I need someone who will create a wordpress form for me. I need this done asap. You will be given an design inspiration (colour, form etc) and the fields and field behavior.

I need you to recreate this: http://ptpwebsitedocu.com/welcome/?page_id=8

Skills required:
Wordpress
About the employer:
Verified
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