Pledge Php script with counter

I’m looking to build a pledge form but need help. Initially I was going to do it in Coldfusion – but GoDaddy doesn’t support that anymore. So – I need it in a form that GoDaddy supports. The website the form will go on our website.

The basics:

1. I don’t need CSS styling done on it – just the very basic layout on an html page – I can do the styling later.

2. I would give you access into the Go Daddy account to configure anything that needed to be configured.

3. I will need a report (which I assume will just be in GoDaddy?) of the list names, city, state, and email addresses of the people who submit a pledge. Also – is there a way to separate the submissions so that one is the people who checked below that they would like to receive emails and those who left it blank? CSV will be fine

4. I’d like to have a counter that counts each pledge and displays the number on that same page – such as the example below:

a. [url removed, login to view]

b. Please just provide me the code for a DIV element that will contain the count.

5. After someone submits the pledge – they will be taken to [url removed, login to view] - it’s not there yet, but will be.

6. I will want an email sent to the submitter confirming the pledge. For now, the copy could just be a placeholder "This is where the copy goes that kicks off to an email from the submitter" - or something like that.

7. Below are the fields the form would need…

Pledge copy

I Am One In A Million and I pledge never to purchase a puppy or dog, cat or kitten from a pet store selling puppy mill animals or from a backyard breeder. I pledge to adopt only from animal shelters, humane societies, and legitimate rescue groups. I am proud to be ONE of the million people who will end the puppy mill industry.

First Name:

Last Name:

Zip Code:

Email address:

(checkbox) Yes, I’d like to receive Pet-Connections emails so I can stay up to date with the latest news & events. And rest assured - we respect your privacy and will not share your email address.

Submit button

Skills: Javascript, MySQL, PHP, Website Design

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About the Employer:
( 2 reviews ) Madison, United States

Project ID: #1279981

5 freelancers are bidding on average $272 for this job


Hello ! Please check my offer through the private message board. Thank you !

$290 USD in 1 day
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I'm happy to work this for you. Thanks.

$320 USD in 7 days
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I will help you,sir. Also check your pm.

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Hello, I'm interested in producing this project, Please read my PM

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If I didn't need a new ISP I'd be willing to do pro bono.

$250 USD in 1 day
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Hello, I am new to but have many years (over 15) experience in software development and web design. I have forwarded more details about myself and how I would complete your project in a private message More

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New to this site, but completely capable of developing you a site that meets your requirements on time.

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