Single HTML form

I need a single HTML page with single form having 4 fields just as the attached image file. Please check the image and I need the exact design that is depicted on image.

Its a very simple design and work and I am estimating this job should be done in 1 hour by experts like you

I am offering $8 to $15 for this 1 hour job

Please don't bid above that


Skills: CSS, Graphic Design, HTML, HTML5, Website Design

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About the Employer:
( 2 reviews ) Los Angeles, United States

Project ID: #14677129