Service Quote Form Based on Zip code

I need a simple tool created that can be embedded into other websites easily.

Similar to "[url removed, login to view]"

The tool will be a simple fee quote form, that will spit out a quote based on a 3 tiers of variables.

1. Distance [ we only service, New York & New Jersey but we need to know if new york city, long island or upstate ny to provide the accurate quote]

2. Quantity [ based on spouse added , and children]

3. Additional Services [ if they add more options like dental , rx etc]

*** Would like to use something like zipstatic to get city***

// Call Ziptastic for information


url: "[url removed, login to view]",

cache: false,

dataType: "json",

type: "GET",

data: "zip=" + [url removed, login to view](),

success: function(result, success) {

or maybe send to specific web pages i have based on if nj+1, nj+2, nj+3 : nyc+1,nyc+2,nyc+3 , ny state +1, etc


Choose State

New York

New Jersey


Get a Quote!

function validate() {

var sel = [url removed, login to view]("stateType");

var link = [url removed, login to view]("mylink");

switch ([url removed, login to view]) {

case "NY":

[url removed, login to view] = "[url removed, login to view]";


case "NJ":

[url removed, login to view] = "[url removed, login to view]";


case "other":

[url removed, login to view] = "[url removed, login to view]";


// oh dear we have selected a wrong option


alert("Sorry, wrong option selected");



I can help build any mysql but maybe API better?

Skills: Data Entry, Data Processing, Javascript, Perl, Website Design

See more: www nj com, quote web service, location services api, location based services api, link build service, get location javascript, perl json, javascript call web service, value added service, val, Rx, LOcation Based services, distance zip code, zip city state, location zip code, state code, simple perl ajax, city zip, build children, mysql quote, option quote, add quote, json form, javascript call api, embedded web services

About the Employer:
( 0 reviews ) United States

Project ID: #4386359

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