NyroModal Window based HTML contact form

• Project ID:

  752348

• Project Type:

  Fixed

• Budget:

  $30-$250 USD
  

Project Description:

We would like to have a contact form on our website where you click on a link on our site to bring up a form in a Nyromodal window. Validate the form on submission and send the results via E-mail. Validation should popup a message box indicating one or more fields were not complete and highlight incomplete fields with message(s) indicating what needs to be done. All of the validation and message boxes MUST take place inside the NyroModal window panel. We would also like the NyroModal based contact form to submit the data without refreshing the NyroModal Window. Our form is as follows:

Fields:
First name (Required)
Last Name (Required)
E-mail address (Required - valid E-mail format)
Phone number (with formatting)
Company Name
Number of employees

Areas of Interest (check boxes)
Health & Wellness Programs
Flexible Spending Account (FSA)
Health Reimbursement Account (HRA)
Health Savings Account (HSA)
Self-Insured Health Plans
COBRA Administrative Services
Workers' Compensation
Physician Recruitment

Comments (Free-form text)

Final notes: The contact form and everything specified above MUST work inside of a NyroModal window panel. NO EXCEPTIONS and NO frames/iframes. If you are not familiar with NyroModal based windows and/or have very little jquery/ajax form validation experience do not bid on this project. Thank you.

Skills required:

AJAX, ASP, HTML, Javascript, jQuery / Prototype