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Write Sourcecode for a Contact Form

Write Sourcecode for a Contact Form

Closed
Entries
3
Prize (USD)
$100

Contest Brief

I need a 2 Steps contact form where the data is saved in a MySql DB using php and jquery
First step:
- Salutation (Mr oder Mrs) whith a checkbox needs to be determined using Radio buttons and saved in the db.
- First name needs to be determined and saved in the db.
- Second name needs to be determined and saved in the db.
- E-mail needs to be determined --> there has to be a check if the email is valid and saved in the db.
- Checkbox for confirming the rules of the webpage needs to be at the form --> if the checkbox is not marked the user can't go further
- Continue Button
--> All Fields are obligatory, if a field is not entered a message should pop up which informs the user. If the email is inavalid also a message should pop up
Second step:
The webpage where the form is embedded shouldn't change only the fields in the form need to change.
The form should now show the following fields which also need to be stored in the db.
- Street
- Number
- zipcode
- City
- Phone Number
- Country (drop box where you can choose three countries)
- Birthdate (a field for day, a field for month and a field for year)
- Button Submit

All the data needs to be stored in a db and in addition an email to the user where he can confirm his input (via a confirmation link) needs to be sent. This also has to be stored in the db.

--> lookup wireframes in the attachement

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  1. Winner
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    entry number 2
     Contest Entry #2 for Write Sourcecode for a Contact Form
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    entry number 3
     Contest Entry #3 for Write Sourcecode for a Contact Form
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    entry number 1
     Contest Entry #1 for Write Sourcecode for a Contact Form
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