Website Form - repost

This project received 9 bids from talented freelancers with an average bid price of $94 USD.

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$10 - $30 USD
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Project Description

I need a form that will allow users to select a category, years of coverage, then the submit button will take the user to a page to purchase the plan based on the category. There will be approximately 8 combinations. I will provide a PSD layout of how the form is suppose to look. The copy will be dummy copy due to the confidential nature of the project. In turn, I will need a commented HTML file as well as supporting css and javascript, so I can update with the appropriate copy and links.

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