A poll form to recollect market data.


I need to create an image that fits the current design, on the main index page. This image will link to a new page (also maintaining the format) that will display a form with 7 questions, that will be answered through check boxes (it will be a poll), at the end of the poll and in the same page, it will have text boxes to enter personal data from the person filling up the poll [name, address, city, phone (work or home), cellphone (all these will be required fields) and comments].

This data should be saved on a .cvs file (duly tabbed) or sent as text via email (also properly tabbed), whichever is easier&faster.

I'll provide the index page as a template for the poll page and in order for you to enter the image that will lead to it.

This job needs to be finished today.

Skills: Graphic Design, HTML, Javascript, Perl, PHP

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About the Employer:
( 10 reviews ) Guayaquil, Ecuador

Project ID: #4164256

11 freelancers are bidding on average $179 for this job


Quality work assured. Ready to get started. Thanks.

$300 USD in 1 day
(438 Reviews)

Hi, I am Bryant, an experienced freelancer with good reviews ( [url removed, login to view]) website: [url removed, login to view] I've just read through your requirement and know the basic idea of the plu More

$200 USD in 1 day
(26 Reviews)

Hello, I Have Applied for your Job and also send my Portfolio. I am ready to start your work right now Thanks

$300 USD in 15 days
(90 Reviews)

Hello, Please check your PMB. Thanks Have a nice day.

$450 USD in 7 days
(17 Reviews)

Thank you for the opportunity. I have a lot of experience working with forms and submitting them to csv files. Let me know if you have any questions. Thanks, Michael

$250 USD in 1 day
(6 Reviews)

Hola buenas tardes Puedo hacer las tareas que mencionas en la oferta. Sabes, no me quedo claro si tu me das la imagen o yo debo crearla. Si debo crearla, creo que lo mas rapido sera copiar una de google que di More

$50 USD in 0 days
(0 Reviews)

Hi, I am a software engineer. I will take 3 days including the future support if any related to work done. I am looking forward to hear from you. Thanks

$130 USD in 3 days
(0 Reviews)

I have created many similar forms recently and I can complete this in no time, with guaranteed results. Please see PMB for more information, thanks.

$30 USD in 3 days
(1 Review)

please check my profile and portfolio..

$125 USD in 3 days
(0 Reviews)

Hi, I am ready to start. Thanks, Saravanan

$30 USD in 1 day
(1 Review)

Easily done, fast, with validation and the UI that u want. Contact me.

$100 USD in 1 day
(0 Reviews)