lead capture form

This project received 1 bids from talented freelancers with an average bid price of $26 USD.

Get free quotes for a project like this
Employer working
Project Budget
$30 - $5000 USD
Total Bids
Project Description

I need to build a 3 step lead capture form. I would prefer it to be in html or php and not flash. I want to collect data in 3 steps. 1: name and email, [CLICK TO NEXT STEP]--> 2: additional detail, [CLICK TO NEXT STEP]--> 3: more data. [SUBMIT] The purpose is that even if the visitor abandons the form I would still have name and email. I also want to either receive all of the data either in 1 email or in some sort of simple back office. You know, log in and download or retrieve data. If not I want to be able to receive all the info in 1 email instead of 3.

## Deliverables

1) Complete and fully-functional working program(s) in executable form as well as complete source code of all work done.

2) Deliverables must be in ready-to-run condition, as follows (depending on the nature of the deliverables):
a) For web sites or other server-side deliverables intended to only ever exist in one place in the Buyer's environment--Deliverables must be installed by the Seller in ready-to-run condition in the Buyer's environment.
b) For all others including desktop software or software the buyer intends to distribute: A software installation package that will install the software in ready-to-run condition on the platform(s) specified in this bid request.
3) All deliverables will be considered "work made for hire" under U.S. Copyright law. Buyer will receive exclusive and complete copyrights to all work purchased. (No GPL, GNU, 3rd party components, etc. unless all copyright ramifications are explained AND AGREED TO by the buyer on the site per the coder's Seller Legal Agreement).

## Platform

Again, I am hoping this can just be code I can plug into my pages or a script.

Looking to make some money?

  • Set your budget and the timeframe
  • Outline your proposal
  • Get paid for your work

Hire Freelancers who also bid on this project

    • Forbes
    • The New York Times
    • Time
    • Wall Street Journal
    • Times Online