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PHP Contact Form - Reposted

$30-250 USD

Completed
Posted almost 16 years ago

$30-250 USD

Paid on delivery
This has been reposted as the winning bidder is now refusing to do the work. Please only bid if you are serious! We are looking to enhance the current contact form that can be viewed at: [login to view URL] The form is HTML and the script should be PHP. We want the contact form to have the following fields: These ones are mandatory fields and there needs to be validation to ensure that they have been populated Your full name E-mail address Your telephone Company name These fields are check boxes and are option fields but at least one of them must be selected. The default value is for them to be blank: PerTOOLS Financial Analysis for Excel PerTOOLS Data Extractor for Excel The following field will be a list (we already have the values that need to be in the list and can provide them): Country When the user selects the submit button there should be validation to ensure the form has been correctly completed. If the form has not been correctly completed show the user an error message explain what they need to change. If it has been correctly completed the following page should be displayed [login to view URL] The data that has been collected needs to be emailed to two different addresses. The first email is to our email address and every time the form is submitted this address should receive a copy of the details. The second email address will depend on which country the user has selected (e.g. if a user selects USA the details go to one email address, if they select the UK the email goes to another address). We need to be able to send request for each country to a different email address. An email should be sent to the Client with the following details: From: Subject: Free Trial Request Content: Thank you for your Free Trial Request. Your request has been passed to your local distributor who will contact you shortly. If you have not received your free trial within 24 hours, please contact Many Thanks The PerTOOLS Team For the look and feel of the form, please look at the current one at: [login to view URL] Feel free to ask any questions. We are looking to get this done as soon as possible.
Project ID: 277686

About the project

19 proposals
Remote project
Active 16 yrs ago

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Dear Sir, I can do this easily. I think can do this not more than 24 hours for first version. Please take a look at pmb for previous works. Thanks
$50 USD in 1 day
4.5 (129 reviews)
7.3
7.3
19 freelancers are bidding on average $50 USD for this job
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Get the delivery within next 3 hours max.... Thanks
$50 USD in 0 day
4.9 (482 reviews)
9.0
9.0
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Very simple, let me do it. Thanks, Tonmay
$50 USD in 1 day
4.8 (130 reviews)
7.6
7.6
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We can provide you complete solution with high quality work and time base completion. Thanks Worldsofttech
$40 USD in 0 day
4.7 (105 reviews)
7.4
7.4
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Please check it out the PM for more info, thanks…
$30 USD in 0 day
4.9 (96 reviews)
6.8
6.8
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Please check your PMB
$50 USD in 2 days
5.0 (9 reviews)
6.6
6.6
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Hi, Lets start. Thanks KD
$45 USD in 1 day
5.0 (38 reviews)
6.6
6.6
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Please check PMB. Thanks.
$45 USD in 1 day
5.0 (45 reviews)
5.9
5.9
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Pls see PMB
$50 USD in 1 day
5.0 (111 reviews)
5.9
5.9
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Hello, please check PM thanks, Marianna
$55 USD in 0 day
4.9 (20 reviews)
5.8
5.8
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can do it right away.. See PMB
$50 USD in 0 day
5.0 (14 reviews)
5.4
5.4
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hi, experienced php coder. thank you,
$60 USD in 3 days
4.4 (4 reviews)
4.3
4.3
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please see your pmb
$50 USD in 1 day
4.9 (8 reviews)
3.5
3.5
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I have a demo ready for you ! Lets finish it in an hour . Check PM plz.
$50 USD in 0 day
0.0 (0 reviews)
0.0
0.0
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see my bid
$45 USD in 1 day
0.0 (0 reviews)
0.0
0.0
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Thank you.
$50 USD in 2 days
0.0 (0 reviews)
0.0
0.0
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it will be done!!!
$65 USD in 5 days
0.0 (0 reviews)
0.0
0.0

About the client

Flag of UNITED KINGDOM
Letchworth Garden City, United Kingdom
5.0
1
Member since May 31, 2008

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