Create a 1 page form

Cancelled

Looking to make a 1 page form with 1 drop down menu + 4 columns of check boxes.

The form simply adds new values to the URL before submitting.

Check the attached image, this is how I want it to look.

The main question (the "what gift should i get") would be the category in the url: [url removed, login to view]

The check boxes would act as tags: [url removed, login to view],column2value,column3value,column4value

I know how to do this, it can be done via simple HTML, but i want it cool looking with some error responses when a certain column is not filled.

The attached image is pretty much how i want it to look like, simple, with the same font... maybe a tad bigger but not much because this will be embedded in a overlay popup.

Extra space on top so I have room to play with (logos, adding a search bar ETC).

Instead of checkboxes maybe have the 4 columns highlight on click? IDK. I want something simple yet web 2.0. Can ya do it? If so, how much? :D

Skills: CSS, HTML5, PHP, PSD to HTML

See more: page to create logos, make a web page, how to do logos, how to create top menu in php, how to create php form, how to create a simple php web, create space logos, create a web page html, cool looking logos, bar logos, logos create, how to create a web page, how create logos, create new logos, create html image via php, Create font, create a font, font overlay, checkboxes css, html image click css, css html tag, create simple html css page, css checkboxes, embedded font

Project ID: #4177201

28 freelancers are bidding on average $78 for this job

toinnisfree

quick pro help. ftp and milestone required.

$135 USD in 2 days
(533 Reviews)
7.9
ssahilsl

Dear Sir/Madam,We always Provide all services such as Web Design & Development, Graphic Design, Landing page Design, Logo, Banner, Brochure, HTML, XHTML, HTML5, PHP, Word press, Joomla, Print Design. Please open messag More

$55 USD in 2 days
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6.7
ROWS

Hi, Placing our Bid... check message for details. regards

$77 USD in 3 days
(159 Reviews)
6.5
surajitsaha24484

We have gone through the project description.We are very interested about the job and ready to start the job.We are sending you some links of our previous xhtml and html5 jobs.We will definitely provide you the best qu More

$35 USD in 1 day
(108 Reviews)
6.5
adpt

HI I will be able to do this. :)

$150 USD in 3 days
(59 Reviews)
6.5
salientcomputer

Hi Please see PMB.

$75 USD in 2 days
(179 Reviews)
6.3
workspaceit

SEO experts etc. We are expertise in web/software development for more than 4 yrs. We work on Php & Mysql, YII,joomla, drupal, wordpress, Oscommerce,cakphp,codignator,kohana (new),asp.net,c#,paypal integration, jav More

$49 USD in 1 day
(21 Reviews)
6.1
Ajcm623

hello i have gone through your requirement though CAN WE DISCUSS IN FURTHER DETAIL?? thank u

$150 USD in 2 days
(63 Reviews)
6.0
jcodemasters

No problem, will be done as described!

$160 USD in 2 days
(49 Reviews)
5.7
SoftDevelopINC

Do you want to find out a Serious programmer? It's me. Please read PMB for more details.Thanks

$100 USD in 3 days
(40 Reviews)
5.6
PhungTran

Only 30$, tell me more please, thank you !

$30 USD in 1 day
(74 Reviews)
5.0
precioussoftware

Hi, Thanks for sharing your insights with Precious Softwares. Our company background, current work and work reviews will make you sure about our experience, capability of project deliverance and quality. Kindly ch More

$150 USD in 10 days
(5 Reviews)
5.0
aestheticflair

Highly Skilled professional. Please check PM for more details

$35 USD in 1 day
(34 Reviews)
4.8
eclipsian

Hi, Please check your PMB for offer

$150 USD in 1 day
(5 Reviews)
4.8
codeware1

Hello Sir, Hope you are well and doing good!!! we are eager to work with you.We are ready to start the project right away. Codeware is a website development company providing professional website design, website develo More

$35 USD in 1 day
(21 Reviews)
4.8
smartframework

I can start immediately and provide a high-quality work. Plz check PMB. Thanks

$75 USD in 3 days
(6 Reviews)
4.3
sanjayindrapuri

I am PHP/Wordpress Expert. I am Working Individually and also having team of experts. Lets discuss your project more in details. Ready to work with you.

$80 USD in 3 days
(34 Reviews)
4.2
raziel27

I am a professional with roughly 6 years experience and a college level degree in the field of web development. For an understanding of my skills please check my portfolio

$30 USD in 1 day
(6 Reviews)
4.0
abhiime

Hello sir, I am abhi , am web developer using php and open sources tool like wordpress and joomla i have fixed your requirement. I am waiting your reply Thanks

$80 USD in 2 days
(8 Reviews)
3.9
IceCream90

Hi, I can do great quality work cheap and fast...please check PMB

$40 USD in 2 days
(17 Reviews)
3.8