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need javascript help for a form

This project received 14 bids from talented freelancers with an average bid price of $6 USD / hour.

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Project Budget
$2-$8 USD / hour
Total Bids
14
Project Description

i need help for a form. its working already i need one value from there... and also neeed one action on the submite button and for that i can give you an html file. so you can make javascript on it. it just few minutes work if you know javascript. Thanks

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