I need someone to create a form for transferring a domain through GoDaddy. Instead of someone emailing me their information, I want them to go to a page and enter the same information that I would use to transfer a domain, and when they submit the information it would be emailed to me. I have attached a screenshot of what the Initiate Account Change form looks like. You will not need to make any drop down boxes. For the State box it should be State/Province. They should get an error message if they do not fill in a box with an asterisk. I can pay through GAF escrow or PayPal. This should be a simple task, and I am looking to pay no more than $30.