Simple PHP Submission Form

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Project Budget
R210 - R1750 ZAR
Total Bids
Project Description

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 Required

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