We are in need of a form page that is capable of sending all the listed information below to us via email. We use a hosting solution that is capble of using either cgi or php, and can also use a pop/smtp account or sendmail to send and receive these emails.
The most important part of this form is the attachments, and we would like to limit the total attachment file size to 10MB.
The information we require is:
First Name
Last Name
Gender
Goal (will provide options)
Age (will provide options)
Email Address
Phone Number (3 boxes that compile to 1 value in email)
Address 1
Address 2
City
State / Province (with current, complete abbreviations for US & CA)
Zip Code / Postal Code (with current, complete abbreviations for US & CA)
Country
Large Text Box (500 words)
Attachment 1
Attachment 2
Attachment 3
Attachment 4
Attachment 5
Attachment 6
Check Box (if unchecked, submit button returns pop up notice that they have not aggreed to the rules.
Submit button