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Fix a PHP page and do a new form page to capture information

This project received 8 bids from talented freelancers with an average bid price of $350 USD.

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Employer working
Skills Required
Project Budget
$250 - $750 USD
Total Bids
8
Project Description

I have need for someone to fix one broken PHP page and do do a new php page based on a form design. The PHP page should have a captcha prompt on the page. Also, on submitting, the page should email the collected data to an email address.

Budget 25 - 50USD.

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