In Progress

Simple Form for Website

This project is being re-posted after it was postponed a month ago.

Our website [url removed, login to view] needs to have a new form built.

Leading up to Christmas, we are giving out a lot of marketing material to the public and we are giving out a lot of Promo Codes. The purpose is to have people come to our website, provide us their first name and the email address, so that they can check the value of their promo codes.

Each promo code is worth a different amount of money which can be used when making a purchase. The promo codes are as follows:

awesome gift = $5

happy gifting = $5

Gift 4 U = $20

Gifts 123 = $50

Regal Gifts = $100

So what we need is a basic form that takes the customers name and email address and then shows them the value of their promo code after they enter it. So the form should have three fields:

1) First Name

2) Email Address

3) Promo Code

Once they enter these three fields and clicked submit, they should go to a page that tells them the value of the code. For example:

"Promo Code = $5"

Only the text would be in red.

All the information on the form should also be emailed to our email account.


We only require the form to be created on its own. We do not need it to be built into the site. Once we have the script for the form, we will have our webdevelopers place the form on the site.

If you can have the form look as close to possible to the attached image, that would be great.

We do not mind which langauge the form is in... as long as it works.

The two images attached show exactly what the form should look like and how it should work. Please let me know if you require any more information.

Skills: AJAX, ASP, Java, PHP

See more: www webdevelopers com, webdevelopers com, value website, promo work, people gifts, name for website, gifts people, gifts for $5, gifts $5, do gifts, codes promo, code for website, code for money, christmas email to customers, $5 gifts, $5 christmas gifts, $5 christmas gift, three form, webdevelopers, us form, text for website, simple account, public works, public re, promo code

About the Employer:
( 4 reviews ) Sydney, Australia

Project ID: #541261

Awarded to:


Please check PM. Thnx.

$30 USD in 0 days
(222 Reviews)

66 freelancers are bidding on average $66 for this job


Hello, I am ready to start right now

$50 USD in 1 day
(287 Reviews)

I can offer my high quality programming services to you. Please contact if interested.

$230 USD in 0 days
(163 Reviews)

Quick work, can be provided in few hours. Kindly check PM for more details

$60 USD in 0 days
(290 Reviews)

I am exited to do this simple form for you

$100 USD in 1 day
(214 Reviews)

We can code this in 2 hours but to "have the form look as close to possible to the attached image" need extra hours. We will deliver in 5 hours. Thanks

$80 USD in 0 days
(28 Reviews)

please check my PMB

$80 USD in 1 day
(44 Reviews)

Hi! I am really interested in taking up the project. I have the requisite experience and the expertise to complete this project with success. Please view my PM for details. Thanks. Regards. GLOBAL TECHNOSYS

$175 USD in 2 days
(152 Reviews)

Sir I can do the work within a day. I hope you will give me chance to work with you. Please check your PMB for more details. Thanks

$80 USD in 1 day
(154 Reviews)

Hello. Please check your PM. Thanks.

$40 USD in 0 days
(84 Reviews)

have a glance at Pm. Regards,

$86 USD in 1 day
(205 Reviews)

Hello sir i am an experienced programmer, i will do your form within a day may be within hours, i will use XHTML/CSS/PHP/AJAX , Jquery and AJax to make it more interactive, Please have a look at PMB. Thanks

$30 USD in 0 days
(56 Reviews)

Dear Customer! I am an expert PHP/MySQL developer with over 6 years of experience and very interested in your project. Ready to start immediately and finish as soon as possible. My bid is for fast professional servi More

$100 USD in 1 day
(170 Reviews)

Hi i can do it Plz check PMB

$135 USD in 3 days
(102 Reviews)

Hi Have Gone through your requirement and understood, we are very sure that we can do your needs with your entire satisfaction. We have left a PMB for you plz feel free to have a look over there. Thnx JSI Team

$100 USD in 1 day
(77 Reviews)

Ready to work! Thanks!

$80 USD in 3 days
(94 Reviews)

please view pm

$50 USD in 1 day
(108 Reviews)

Hello! i'm Toan i'm expert with design, php code, php , php opensource ( joomla,woodpress,opendCart,Zencart,Magento,payment setting)framework(codeIgniter,cakephp) psd xhtml, css validate with w3c, javascript, jquery js More

$50 USD in 0 days
(63 Reviews)

I can do this very well.

$30 USD in 1 day
(46 Reviews)

Ready to start right away. Please refer PMB. Thanks.

$30 USD in 0 days
(32 Reviews)

See PM for details.

$40 USD in 1 day
(46 Reviews)