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Easy Php or Perl coding

This project was awarded to chieftain for $30 USD.

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Employer working
Awarded to:
Skills Required
Project Budget
$30 - $100 USD
Total Bids
1
Project Description

Hello guys!
Very urgent. Look at this page [url removed, login to view], there is form on the left. I need the same with one additional field at the bottom. So, actually it is extremely easy for anybody who knows Perl or Php. Maximum bid is only $20.
I need an individual who can do it quickly.

P.S. Submitted information from that form must be send to e-mail.

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