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Simple PHP Submission Form

I Need a simple PHP submission form that will allow users to place orders for either a Cartridge OR Paper

Upon submission the form will need to insert these entries into a mysql table

Fields should be

(1)User Detail

--------------------

User Name: (Str field)

Full Name: (Str Field)

Cell No: (reg expression verification)

Email: (verify if email is valid)

Location: (String field)

(2)Device Detail

-----------------------

Serial Number: (String Field) - Should have the ajax function to lookup the model of the device, if serial does not exist in table it should be added

Model:(String field)

Meter Reading:(Integer field)

Current Supply Level: (String Field)

(3)Order Detail

---------------------

Paper: (Radio Button (Yes/No) - If Yes, a new field should appear with a quantity field)

Cartridge(Radio Button(Yes/No)

Image Verification(Captcha)

----------------------------

Submit Button

----------------------------

Skills: MySQL, PHP, Software Architecture

See more: form submission mysql php, php mysql captcha form submit, quantity verification, php full form, str, image submission, mysql expression, php device, paper architecture, lookup table mysql, ajax simple insert mysql, ajax simple insert, email form verification image, captcha appear, php mysql model, php expression, architecture paper, php model mysql, php lookup, submission form, string reg, php ajax function, mysql serial, cell number lookup name, captcha form php ajax mysql

About the Employer:
( 0 reviews ) Pretoria, South Africa

Project ID: #4128664

43 freelancers are bidding on average R915 for this job

NetzPro

Dear Sir, We would love to get this opportunity of working with you. We can guarantee complete satisfaction if you select us to execute this project. Regards NetzPro

R5000 ZAR in 5 days
(368 Reviews)
8.5
codegur

Check PMB for Details.

R600 ZAR in 15 days
(219 Reviews)
7.5
sonuinfy

Please check PMB for more info.

R2000 ZAR in 4 days
(171 Reviews)
7.2
pan09

Can do it right , Ready to start

R650 ZAR in 2 days
(167 Reviews)
7.2
WebBizSolution

I run European website design firm with years of design experience personally developing over 300+ websites. I can also provide a list of references from past customers if you'd like. I'm not the cheapest you'll find, More

R1750 ZAR in 15 days
(54 Reviews)
7.1
ranganalx

Hi, Good day! I can do this. What would happen once form submission? Just send you an email and what about for the user who submitted it? Hoping to hear from you. Thanks!

R1750 ZAR in 5 days
(272 Reviews)
6.7
zk230182

Hey Good Day,I've studied your project specifications and I'm ready to provide you solution that fits your [url removed, login to view] private message for detail

R2000 ZAR in 5 days
(46 Reviews)
6.5
adpt

HI I will be able to do both ajax and php form. Thanks Adipti

R1400 ZAR in 2 days
(60 Reviews)
6.4
imranihsan

See PM. Thanks

R750 ZAR in 2 days
(97 Reviews)
6.4
Mario

PHP Expert here ! Let's start.

R1750 ZAR in 4 days
(78 Reviews)
5.9
csajit

LETS GET IT DONE QUICKLY

R600 ZAR in 1 day
(136 Reviews)
5.7
phpplay

I can make it complete.

R450 ZAR in 2 days
(19 Reviews)
5.6
maasoft

Lets do [url removed, login to view] to start immediately.

R800 ZAR in 1 day
(64 Reviews)
5.6
BoxStudioDesign

Hi, I have strong expertise with PHP and if my bid were kindly accepted by yourself then I could start immediately and have it done within a matter of hours.

R600 ZAR in 1 day
(34 Reviews)
5.4
sonarkaushik

Sir, I can do the project. Refer PMB. Looking for further discussions in this matter. with thanks and regards

R1400 ZAR in 4 days
(33 Reviews)
5.4
huyit

Dear, let me help you create the form. Kindly view PMB to further information. Thanks

R500 ZAR in 2 days
(31 Reviews)
5.1
pixecs

Hello sir, i can help you with this project.

R275 ZAR in 2 days
(32 Reviews)
4.9
mondersky

your satisfaction is my first goal. trust me.

R750 ZAR in 5 days
(21 Reviews)
4.6
bdlancer09

I can do this!

R300 ZAR in 1 day
(46 Reviews)
4.6
anisoftcorplx

Hi, Greetings of the day. We are professional php development company looking forward working with you. Please look into private message section for detailed development model and approach. Thanks, Anirban

R1100 ZAR in 4 days
(24 Reviews)
4.4