Add a Contact Us section to My Site:
State (use a drop down - only need to include NJ, NY, PA, CT)
Date of Birth
Error checking for required information
Error checking for data type, size, and basic format (especially important for date of birth)
On the form processing page:
Show today's date
Echo back the visitor's age in years
If the visitor is older than 55 indicate that they are entitled to a senior citizen discount
If the visitor is 30-54 years old indicate that they are entitled to a middle aged citizen discount
If the visitor is younger than 17 indicate that they are entitle to a youth discount
Echo back the users first and last name.
For example, my results page might be something like:
Mark Hu thank you for contacting us. Today is May 12, 2012. Since you are 64 years old you are entitled to our middle aged discount.
Zip all files and please
Form present and nicely formatted
Required elements enforced
Error checking applied and working correctly
Processed form displays user name
Processed form displays today's date
Processed form displays appropriate response
9 freelancers are bidding on average $36 for this job
My bid includes Spam protection, if you don't have spam protection and a bot finds your contact form you're going to get a lot of fake submits unless your contact form is hidden from the search engines.
Hi, I am interested in your form project. Please provide the link to the current site so we can match the current styling. Looking forward hearing from you soon.
I invite you to work together for this project. I bid with the lowest price I can do for you, to build my reputation on freelancer as a freelancer and not as an employer this time :)