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Email form with automatic reply

This project received 34 bids from talented freelancers with an average bid price of $91 USD.

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Employer working
Skills Required
Project Budget
N/A
Total Bids
34
Project Description

I need an email from for my website. It's not too complicated, but this is basically what I need:

1) The form should include the following fields:

1. Name (text field)
2. Email (must be mandatory field), must validate it's a valid email. (text field)
3. Date (it would be nice if some little calendar pops when user clicks on this field, and allows to user to chose a date). (pop up calendar is not required, let me know how much more for this feature).
[url removed, login to view] (text area)
5. Attach file (user can click this button and attach a file to the email to be sent)
6. Additional notes (text area)

2) There should be some sort of CAPTCHA where the user enters the letters in an image in order to avoid spam

3) When the user clicks submit button, user should be redirected to a "Thank you" page within my site.

4) I want the email to be sent to my email address. I'm not sure how you're going to handle sending the email, but if you're script requires my email address and password then that's ok.

5) The script should access my email account and generate a confirmation email letting the user know that his/her request has been received.

Let me know how much this would be.

Thanks.
Tony

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