Online Warranty Return Form(repost)

I need a web page designed. The page will have the same look and feel as our current website. The page will consist of a form that will gather information from a customer about a product. It will have the standard elements like required fields, drop down list, pop up calendar, submit and clear, and the capability to e-mail a specific group of people based on a drop down selection. Next the results will then be used to fill out a professional looking form/printout that will need to have two copies, one that reads "Customer Copy" and the other that reads Original. The original document that this page will need to be designed around is already in existence and will be provided as a guide for both the web page and the print out. Microsoft Visual Studio .NET 7.1 Code Language- C# ## Deliverables See the attached document. This will be the form from which the web page will be created. Web page must be written in a language that is easily maintained via Dreamweaver CS5 (HTML). **Web Page Details** **Banner** Web page will need a placement for a banner at the top that will be as wide as the page and 95 pixel high. You do not need to worry about the graphics but need to provide me a place to put an image. **Navigation Row** A second row below the banner will also be the width of the page and 30 pixel high. I will use this row to personally place navigation images/links into. You do not need to worry about this navigation bar, the links or images. **Body** Using the attached document, create a page that will be entitled Vendor Credit Application (VCA). All GRAY cells are the cells we will need to have the visitor populate with their information. The **asterisks denote required fields. At top of the form the following should be included "Vendor Credit Application (VCA) This form is for Non-Carrier product warranties only. All Carrier product must be processed through the NOW!Plus website. If you are in need of immediate assistance CLICK HERE for live online support." * Note to designer- I will provide the URLs for the two underlined links above.* **ELEMENTS/FIELDS Today's Date-** Simply used to show the visitor what today's date is. **VCA#**- A random generated 8 digit number, that is to never be duplicated. Perhaps using a serial number based on the date and time of the form created. We are looking to control these documents with this number and so must never duplicate. **Processing Warehouse**- (required) Drop Down Box with the following choices * Flint * Grand Rapids * Lansing * Livonia * Madison Heights * Toledo **Return Method-** (required) Drop Down Box with the following choices * Hand Carry * UPS/Mail * CGL Truck **Company Account #-** (not required) a minimum field length of 5 digits **Company Name-** (Required) a minimum of 32 field length for text. **Street Address-** (Required) a minimum of 32 field length for text **State-** (Required) a minimum of 2 digits for text only **ZIP**- (Required) a minimum of 5 digit field for numbers only **Phone #**- (Required) Three fields to collect Area Code (3 digits), Prefix (3 digits), and Suffix (4 digits). **Contact Name-** (Required) a minimum of 24 digit field for text **Item Number (1)**- (Required) a 24 digit field for both text and numbers **Serial Number (1)-** (Required) a 24 digit field for both text and numbers **Quantity (1)-** (Required) a 4 digit field for numbers only. *Note to designer*- do NOT include "(1)" in the field names above. This is only to represent that I will need a total of 5 of these Item Number/SerialNumber/Quantity combinations in all, with the first one (1) being the only required fields. We know that 90% of visitors will only fill out one number per visit but there will be 10% that will fill out 2 or more lines. **Additional Item Number, Serial Number, and Quantity fields** for a total of 5 differently lines in which to add additional part numbers if desired by the visitor. **Noticeable separation between the table/fields above to be inserted here.** (Same page), below the separation. **Warranty Part Install Date-** (required)- Include a pop-up calendar that allows the customer to select a date that goes back as far as 2005. **Warranty Part Failed Date-** (required)- Include a pop-up calendar that allows the customer to select a date that goes back as far as 2005. **Replacement Part Repair Date-** (required)- Include a pop-up calendar that allows the customer to select a date that goes back as far as 2005. **Valid Failure Description ("Broke", "Replaced", "Repaired" are not valid descriptions): ** (Required) This is a comment field that will allow a minimum of 250 characters. **Created Form** **Details** This form will take all the elements above and fill out the attached document. It will include the following: * Our Company Logo * VCA number * Date Created * Data that is provided from the web page * Internal Use Only fields as shown on document attached as well as a line for the "Tied PORM#" as seen on document. This form will generate TWO copies/versions. The first copy/version will say CUSTOMER COPY. The second copy/version will say Carrier Great Lakes Copy. The idea is that the visitor will fill out the web page, submit the form and the customer will have a form created that will allow him to print and save one copy for his records and the second copy to be given to MY COMPANY. At the same time the data that is created on the form will be sent via e-mail to a specific group of people **based on the processing warehouse selection** made in the original form. See the following for details. Note- **if** an additional web page is required to produce this print out, this will be expected to be included in the quote. **E-mail Process ** Based on the **Processing Warehouse** selected in the original form page, the data will be sent to a specific set of users. For example, if the user selects the LIVONIA warehouse, the e-mail will go to joe@cglcorp, jim@[login to view URL], and bob@cglcorp.com. If the user selects TOLEDO warehouse the e-mail will be sent to jeff@[login to view URL], john@[login to view URL] and peggy@cglcorp.com. And so forth. There are 6 warehouses total, you will be given the 6 different list of e-mail addresses (the ones used above are examples only). The e-mail must contain the following, in a very user friendly, organized and easy to read and understand format: * VCA number * Date Created * ALL Data that is provided from the web page form. **OR** **(PREFERRED)**- A PDF copy of the printed form the customer will print/receive once the form is completed (see the section above entitled **Created Form** **Details**). **SUPPLIED** Any logo's or art work needed during the development process will be provided by me in a timely manner. Banners and navigation will be provided after the project but the above requirements must be met to provide room for these images and navigation. Warehouse group e-mails for the e-mailing process. Hyperlinks will be provided by me in a timely manner. Upon completion you will be given access to our server to move the code to the live environment.