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Dynamic Registration Form

Create a registration form with dynamic elements for class registration. Form also has to collect Credit Card details securely*.

The form needs to be able to securely transmit the data so that the information can then be printed in a reader-friendly way. The user should be able to review the data/registrations before it is submitted to confirm accuracy and the form should also email a confirmation to the user saying the registration has been received.

Please see attached files for a rough HTML example as well as a word document outlining the fields required.

The form will be set up on a subdomain of my website and hosted on a server with an SSL certificate.

*Currently the payment processor is Beanstream which supports Tokenization aka Secure Payment Profiles in order to collect the Credit Card information without charging the card any amount. We need the ability to manually charge the customer after registration. Please see link below as a resource for PHP integration to create Secure Payment Profiles:

[url removed, login to view]

I am open to integrating with another payment processor or service (Stripe seems to have this same ability) in order to accomplish this if there is a better way. Currency is Canadian.

The form does not have to look nice. I will add styling myself.

Please outline in your bid how you would make sure the information is secure and what payment processor you would integrate with.

Skills: HTML, Javascript, jQuery / Prototype, MySQL, PHP

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About the Employer:
( 0 reviews ) Canada

Project ID: #4762134

18 freelancers are bidding on average $528 for this job

toinnisfree

pls chk pmb

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buraqtech

Check your PMB for details!!!

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genisofttech1

Greetings! from Genisoft, > 10 years old company > 170+ project reviews > 25 multi-skilled workers. >Details in PMB Regards [url removed, login to view]

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rajeshsonisl

Quality work assured. Ready to get started. Thanks.

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scriptphp87

Hello Please read more than private message thank you

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techwelfare

Hi we checked your requirement,We could develop as per your need. u could check that out. we would work till your satisfaction. Thanks & Regards Techwelfare Please check inbox for our previous work.

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diegou

Expert coder here

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mikesteve

Hi, Experienced developer here. Check details in PM

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einstech

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farhaoui

Thank you for giving your precious time to review my bid and check PM! Our Reviews speak for us. Thank you

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miniric3

Kia ora! [url removed, login to view] are a NZ based web and software design company who have seen you here on the freelance market and are really excited about working with you and treating you to the full service, professional experi More

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on2it

Kia ora! on2itonline are a NZ based web and software design company who have seen you here on the freelance market and are really excited about working with you and treating you to the full service, professional experi More

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manish973

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thesaw

let's begin

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JackBauer91

Please Check your pmb.

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Srmithi

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renjilal

I am ready to take this work.

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arp19690

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ashuagrawal

Please see Private Message in Details (Y)

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EdificeSoftech

Hi, Greetings !! We would like to offer our expertise to develop your website as per your initial specifications. We are a team of developers and designers who have more than 4 years of experience in solving all kin More

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