Instant Quote Form


I have a set of variables that go into giving a lead an instant quote on workers compensation. The variables are in csv format, not sure if this matters.

What I need created is an form that I can put onto my website. When they fill out the form criteria I need the form to produce an instant quote based on the criteria in the csv on the site. Along with giving the lead an instant quote, I need the form to capture the lead information into Infusionsoft.

If you have questions or need clarity, please feel free to send me a message.

Skills: MySQL, PHP

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Project ID: #4371302

Awarded to:


Recently completed a similar form please refer to pm for sample.Ready to start right away.

$50 USD in 3 days
(43 Reviews)

11 freelancers are bidding on average $110 for this job


Hi, i'm professional webdeveloper and webmaster, i have strong knowledge of all required technologies, and i would like to offer you my services. Please send me more information about this project (specification) by pr More

$250 USD in 5 days
(101 Reviews)

Hi there, We are experts in PHP Open Source (any kind of PHP/MySQL work),wordpress and Ajax/Web 2.0 technology. Some of the projects we completed for php are mentioned below More

$300 USD in 5 days
(71 Reviews)

Interested. Need more details please! Cheers!

$140 USD in 3 days
(16 Reviews)

I have read your requirements and I am confident I can deliver for you.

$125 USD in 3 days
(15 Reviews)

Lets start the work. Thanks.

$40 USD in 3 days
(9 Reviews)

Greeting, I'm very interested with your project, can we discuss further like: how your form look like (how many fields are there in the instant quote, where to get these data, only calculate from input criteria or need More

$110 USD in 2 days
(5 Reviews)

Hi there, I believe I can create this form for you along with the backend processes to provide the instant quote to the user. I have sent you a PM with some additional questions.

$60 USD in 2 days
(4 Reviews)

Dear Employer, I am an experienced JavaScript coder and has been in the field of web designing and developing for years now. I am specially experienced in creating JavaScript calculators. I have put the portfolio regar More

$35 USD in 3 days
(1 Review)

Hi, we need discuss. please check PM. Thanks

$70 USD in 3 days
(0 Reviews)

Greeting for the day! I have gone through your requirements and would like to express my interest for the Instant Quote Form. Our expertise includes SEO, Wordpress, PHP, Open Source CMS (Magento, Drupal, Joomla More

$30 USD in 1 day
(0 Reviews)