515916 Simple Ajax Job 2

Quite simply, I have a form that has different form elements. Based on the selections and data entered, you need to write a simple ajax element that creates the data in a particular format to the right. Basically, you need to add onblur and onchange where applicable and upon entry, there should be an instant rendering of the text formatted properly. If you are good with ajax, this is a simple 1.5 hour job at the most. The budget for this is $20, but the first one to show they can do it for $15 will get the job instantly.