HTML Form coding / repair.

I need somebody to set up a Form for one of my sites. Preferably in HTML, or at least independent of particular server (since I will be changing hosting provider as soon as my contract is up). More accurately, I need somebody to fix up the mess that I have already created - not working, of course.

Link to form is “Assistance Request Form” just below fold on my index page:

[url removed, login to view]

Form page layout is not finished, as will be obvious, but don’t worry about that. (I need to add quite a bit of text below the form, but that won’t affect the form itself.)

What I want to do is email form data, as you will deduce from the existing (not working) source code.

Please let me know what else you need, and any ideas might have for best procedure (browser compatibility, security, avoiding user warnings about activex code, etc.)

I will want to include (via the “subject” parameter, presumably) a different subject line – depending on which folder / page group the email originates from.

Skills: HTML

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About the Employer:
( 20 reviews ) Edgecliff, Australia

Project ID: #4268525

Awarded to:


I can make this form working and send all data to your email id.

$50 AUD in 1 day
(32 Reviews)

29 freelancers are bidding on average $110 for this job


html/php devloper

$200 AUD in 2 days
(20 Reviews)

HTML/CSS/JavaScript expert here. Please let me take care of your web form.

$200 AUD in 3 days
(33 Reviews)

Actually from your description there is only one thing I got is that you want html form and the form data should be email. Apart from this I have doubt what you want to say please elaborate

$100 AUD in 2 days
(30 Reviews)

pls tell me more detail. then i will work immediately. Thx.

$88 AUD in 2 days
(33 Reviews)

hey lets start right now thanks

$50 AUD in 0 days
(24 Reviews)

Let's Start... Accept our BID. Check PMB. Thanks

$250 AUD in 7 days
(10 Reviews)

Hello, I can code the html form with a working php email script so that it can capture data and send it to a email id. I can also add javascript based form field validation to check whether a field has been filled u More

$50 AUD in 1 day
(12 Reviews)

Need to discuss this in detail,how we can start the discussion on this requirement. for more detail check in PM.

$220 AUD in 10 days
(3 Reviews)

We take this opportunity to introduce Trivia Info as a professional service provider. Please check PMB for more details.

$50 AUD in 0 days
(23 Reviews)

Dear Employer, we're LogoDesire, a Graphic & Web design company, highly interested to do this project and just reviewed your entire project details as you need to set up a form of your website, we believe we'll definit More

$100 AUD in 3 days
(10 Reviews)

Id be grateful and honored to work on this project. Consider it finished in three hours. Hoping you could consider my offer.

$40 AUD in 0 days
(3 Reviews)

Hi, Hope you are doing great!! "I can start right away." Thanks for your time and consideration. For more details, please see your private message box. Regards, Anshika

$100 AUD in 2 days
(10 Reviews)

HI, Expert here, let's discuss and get started. Let me know if you have any questions. Please check our portfolio here: [url removed, login to view] looking forward to hear from you soon. thanks, DT

$170 AUD in 15 days
(1 Review)

Please see PMB

$45 AUD in 1 day
(7 Reviews)

Hello Hiring Manager, please visit your PMB for more details about my work ,skills and expertise. I have read your given core description of project at our best and will surely give better results.

$55 AUD in 2 days
(10 Reviews)

Hi, I can work that form. Ready to start.

$75 AUD in 2 days
(9 Reviews)

I can fix your form and also help you on setting your website to work properly. I can start immediately once chosen. Please view PMB for some samples of my works. Thank you

$100 AUD in 2 days
(1 Review)

Hi there! I look forward to working with you on this. I've worked with forms quite a few times before. In fact, two of my first jobs ever on Freelancer were creating and modifying forms. If you'd like a sample of my wo More

$50 AUD in 2 days
(7 Reviews)

Hi Ready to start Immediately. Having 5+yrs of experience. Please check PMB.

$125 AUD in 2 days
(8 Reviews)

I'm a professional programmer, I can make any form for you! You won't be disappointed look at my reviews =) PM me with questions and details =)

$150 AUD in 1 day
(2 Reviews)