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Simple PHP Submission Form

This project received 44 bids from talented freelancers with an average bid price of R901 ZAR.

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Employer working
Skills Required
Project Budget
R210 - R1750 ZAR
Total Bids
44
Project Description

I Need a simple PHP submission form that will allow users to place orders for either a Cartridge OR Paper
Upon submission the form will need to insert these entries into a mysql table

Fields should be


(1)User Detail
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User Name: (Str field)
Full Name: (Str Field)
Cell No: (reg expression verification)
Email: (verify if email is valid)
Location: (String field)



(2)Device Detail
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Serial Number: (String Field) - Should have the ajax function to lookup the model of the device, if serial does not exist in table it should be added
Model:(String field)
Meter Reading:(Integer field)
Current Supply Level: (String Field)



(3)Order Detail
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Paper: (Radio Button (Yes/No) - If Yes, a new field should appear with a quantity field)
Cartridge(Radio Button(Yes/No)

Image Verification(Captcha)


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Submit Button
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