simple form and DB table + design forms

This project received 7 bids from talented freelancers with an average bid price of $30 USD.

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Project Budget
$30 USD
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Project Description

Very simple form in PHP, and a MySQL table that stores the information on it.

This form should be designed using jquery templates which , and that design needs to be done to another form, which now looks like this ([url removed, login to view]).

This job needs to be done today.

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