Fix a PHP page and do a new form page to capture information

I have need for someone to fix one broken PHP page and do do a new php page based on a form design. The PHP page should have a captcha prompt on the page. Also, on submitting, the page should email the collected data to an email address.

Budget 25 - 50USD.

Skills: AJAX, Javascript, PHP, Website Design

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About the Employer:
( 8 reviews ) Alpharetta, United States

Project ID: #1544032

8 freelancers are bidding on average $350 for this job


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$250 USD in 1 day
(102 Reviews)

Thanks for your job post. We are ready to take up this work.

$300 USD in 3 days
(27 Reviews)

i would like to start your work asap, thanks.

$250 USD in 3 days
(37 Reviews)

I'm web Developer & designer I can do it right now check pm

$250 USD in 2 days
(38 Reviews)

Heya, I can give you a hand. Regards, Brad

$250 USD in 0 days
(25 Reviews)

Hello sir, We are a web development company and we have a dedicated team of expert designers & developers having skills in web technologies and application developments. We have expertise in SugarCRM, Html, XHTML, More

$500 USD in 15 days
(0 Reviews)

Pls check PMB.

$750 USD in 1 day
(0 Reviews)

NOTE: MY BID IS FOR £35.00 GBP. I can complete this task for you in 3 days. Mainly because I work 8am-5pm, so only have 4 or 5 hours after work. My bid states 3 days because I want to ensure all details are complete More

$250 USD in 3 days
(0 Reviews)