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NEED Quick: PHP Form That Creates HTML Page

I am having a difficult time building a contact us page on my website with the layout.

It's the same layout everytime, but I just want to be able to input the information into a form, then click: Get HTML

and copy and paste the code into my wordpress page thatis 980 pix wide and I have some site s that are only 640 Pix wide.

i WANT it built in PHP. So I need someone to build a simple form that allows me to put in fields like company name, about us, long / lat, and have it give me the html for me to copy and paste into my web page.

-->> PM ME WITH YOUR .PHp experience with wordpress and building forms.

Attached is an example of the form and the exact output and layout I would liek the form to build for me.

(not all the fields are in the input form)

---> Please view the attachement and I NEED THIS DONE ASAP.

---> I will have more projects if you do well on this one, so PLEASE PM ME YOUR EXPEREINCE

HAPPY BIDDING!

Skills: HTML, Javascript, PHP, Script Install, Software Architecture

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About the Employer:
( 16 reviews ) Jupiter, United States

Project ID: #1139819

30 freelancers are bidding on average $81 for this job

lightcresent

Expert in doing this sort of stuff... No upfront needed, all payments through Milestone Payment (Escrow).. Online 16 Hours a day, Can start right away.. Thanks

$100 USD in 1 day
(553 Reviews)
9.1
naumanrandhawa

Hi, Please check pmb for details.

$70 USD in 0 days
(168 Reviews)
7.5
grazianno

Hello, please check your PMB.

$60 USD in 1 day
(209 Reviews)
7.0
abraham66

Will be done in 24 hours!

$125 USD in 1 day
(97 Reviews)
6.8
Samtiger2

Consider it Done..... Hope to achieve next positive feedback from you !!! Please check you inbox. "Always willing to walk extra miles to achieve Excellence"

$119 USD in 1 day
(77 Reviews)
6.8
froiden07

I can do this task

$80 USD in 3 days
(237 Reviews)
6.8
phpxpert89

Hello Familylife, I am a PHP developer, can you please check my private message? Thank you!

$100 USD in 0 days
(45 Reviews)
6.5
sameside

Hello I can help you, 6 yars of experience with wordpress, programming plugins, widgets and themes. I can do this job for you. Ready to start. Regards,

$50 USD in 1 day
(96 Reviews)
6.4
Magjoom

I do it sir

$60 USD in 0 days
(30 Reviews)
6.4
guruwebsolutions

*******Dear Sir, We are experts with similar expertise to your project requirement. We are very much interested & eager to provide professional and quality service for you. Please check private message to discuss furth More

$75 USD in 5 days
(39 Reviews)
6.4
tonykim100

Hello sir! Please check PMB.

$100 USD in 0 days
(145 Reviews)
6.3
z115corporation

Expert in doing this sort of stuff... No upfront needed, all payments through Milestone Payment (Escrow).. Online 16 Hours a day, Can start right away.. Thanks

$160 USD in 2 days
(84 Reviews)
6.2
hemantrps

Hello, I have over 5 years of development experience. I would like to discuss your requirements in further details. Please check your PM. Cheers, Hemant

$50 USD in 1 day
(19 Reviews)
5.6
itambassadorz

Ready to start.

$55 USD in 1 day
(19 Reviews)
5.0
phpopensource

You are asking for form generation code which can be generated using any panel or so. This is an easy task. Please check details in private message.

$50 USD in 2 days
(26 Reviews)
4.7
kumark9472

@@@ --- Please check pm for more details. --- @@@

$45 USD in 2 days
(12 Reviews)
4.5
joomlaexpert4yrs

please check PMB.

$70 USD in 2 days
(21 Reviews)
3.8
jazzwakf

Hi, Please check my profile in your PM Box. Thanks

$90 USD in 2 days
(1 Review)
3.5
Sohag07Hasan

wordpress,php expert wants to help you with your project, please check you pm for details

$30 USD in 1 day
(5 Reviews)
3.3
austratech

hi read pm for [url removed, login to view]

$70 USD in 2 days
(4 Reviews)
3.5