PHP payment form

  • Status Completed
  • Budget £20 - £250 GBP
  • Total Bids 24

Project Description

Hi, I need to create a simple form to allow my customers to choose how they would like to be paid.

I would like users to be able to choose from a pull down menu the payment method. Once selected a form is shown for that particular payment method. When the form loads it should automatically switch to the current payment method.

The payment methods are...

1. Check

Name to print on check.

Address line 1

Address line 2

Address line 3

Address line 4


2. Check sent via Fedex

Same form fields required as check.

3. Payoneer

No form fields required just a save button.

4. Direct deposit

Name of account holder

Bank name

Routing number

Bank account number

5. International wire

name of account holder

Bank name


BIC number

The form needs to be checked for valid data. Check all required fields contain data and it is in an appropriate format. I will take care of the css, design and mysql integration. I just need the basic form layout, css/javascript to make the form work and the php file to verify the data.

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