PHP/HTML Legal Lead Form

In Progress

I need a good looking form for capturing legal leads. Use Tables or CSS but you need to provide all graphics and the form needs to look clean and professional. The form must be in PHP (preferably CodeIgniter) and HTML only and well commented so I can maintain it on my own going forward.

The form will need 1-3 "pages" or "stages" - i.e. user provides name and zip clicks on submit button labeled "Next Step" and is prompted for their address, etc. I expect we will need 2-3 iterations to get the form to my liking so please price that into your bids.

Two example forms can be found in the upper right hand corner of the content area at these URLs:

[url removed, login to view]

[url removed, login to view]

I am looking for 1 form now and if I like your work several more will follow. The project must meet these requirements:

1) PHP (I prefer you use CodeIgniter but it isn't required), HTML & CSS - no javascript unless we discuss it prior to delivery

2) PHP tools for form validation must be included; PHP validation code you provide must include validation of these user entered fields at a minimum

a) valid zip code - 5 char string, all numbers, etc

b) name (first and last) - string length > 1, no numbers, symbols, etc

c) physical address

d) email address

e) phone number

3) All source is provided unecrypted and commented

4) All graphics are provided as well - make sure they are licensed for public use, I don't want any graphics that will get me in trouble

5) Output of form stored in an associative array with meaningful name and saved to a text file using JSON (json_encode specifically) for later processing (insertion into a DB)

I'm looking to turn this around quickly but with 3 kids I may not be available this upcoming weekend. Please don't get cranky about that, I will make myself available as much as possible.

Skills: Graphic Design, HTML, MySQL, PHP

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Project ID: #1548484