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Referral Submission Form (PHP and MySQL)

This project was awarded to samaybhavsar for $150 USD.

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Project Description

Referral Submission Form (PHP and MySQL)
We are looking for a developer to build a Client Referral Submission Form with the fields shown below. The tricky part is that the client doesn't know how many referrals they will want to make, so we are looking for easy ways to repeat the form depending on the number of referrals the user wants to submit. Ideas?

Please provide an estimate of what it would cost to create this form and simple database. If possible, we would like the output to be an Excel spreadsheet (emailed) for each referral (that includes the info on the person referring and the referral's info).

Requirements:
Must work on a Linux server using php and MySQL.
Please include approx turnaround time for this project.

Site creative will be provided.
Please post any questions via PM.

Fields include:

Your name
Company (need to try and place the referral at their company)
Your Phone
Your Email
Your Mailing Address (needed for contest winner)

I am referring the following colleagues...

Referral Name
Referral Email 1
Referral Email 2
Referral Phone
Referral Last Known Company
Referral Specialty - if known
Radio Button or Check box: Yes use my name when you contact this referral or No, please do not use my name

Thank You Page:
Thank you for your referrals! Your form has been successfully submitted and your name has been entered into the contest once for each referral on the form.

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