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Contact Form with IP

I need a Contact Form with IP Block where user can put some IP address which will then hide his/her original IP and will use the given IP to access the site, in other words will replace the original IP with the given IP. Site name will also be given by the user. Check the attached file maybe it will clear the point what I want. I need this to be done within 2 days max. (API key will be provided later) BUDGET IS: 30$ Only can't pay more than that.

Skills: Graphic Design, HTML, HTML5, PHP, Website Design

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About the Employer:
( 5 reviews ) Karachi, Pakistan

Project ID: #2560782

5 freelancers are bidding on average $30 for this job

jamalMohamedf

Hi, I can do this. Please check PMB. Thanks.

$30 USD in 2 days
(10 Reviews)
4.8
amama

May my 5 years experience in web development in many domains can help you

$30 USD in 1 day
(1 Review)
1.0
GroBam

I have experience working with PHP so I think I can handle the job Please check the PM so we can discuss more

$30 USD in 1 day
(0 Reviews)
0.0
mnoquiao

Let me handle the job for you buddy!

$30 USD in 1 day
(0 Reviews)
0.0
Zx32E5hIO

Custom software development: w w w . The Administrator removed this message for containing contact details which breaches our Terms of Service . i o

$30 USD in 1 day
(0 Reviews)
0.0
XH23Ke4Tk

Custom software development: w w w . The Administrator removed this message for containing contact details which breaches our Terms of Service . i o

$30 USD in 1 day
(0 Reviews)
0.0