Contest or Survey Online HTML 5 Form

This project received 20 bids from talented freelancers with an average bid price of $201 USD.

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Project Budget
$30 - $250 USD
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Project Description

This form should be done in html5.
It will be compatible with mobile and desktop computers.
The design of it doesn't be neccesary that looks like this one, it could be improved in appareance, if you have any
fancy template that looks like this one, go ahead and use it.

It must use any fancy script like jqueary, ajax or another that could do the jump thing on every question, I don't want it jump each question as a new page with difeferent url.

Any script used should be compatible with mobiles devices.

The data of each question answered by the user must be
captured in a database, it could be saved as microsoft
excel file or CSV file.

In the example are 4 screens, sometimes I could use 3 or
5 pages, so, the design should be friendly to change.
I got knowlodge of html, so I can deal with it.o
Please add the title in tag titles inside the html design
or whatever programing language you use to be easy when
I want to make any changes.

In the email capture screen is a must that the email of the
user would be recorded in 2 places: the database file and the Aweber form.

Please show any examples of any kind of job you should have that looks like this one that I am requesting.

Thank you

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