simple website form with 2 fields


I would like to have a simple form built that would be place ontop of the "Today's Deals" box at [url removed, login to view]

The form is to have two fields

1. a field for email input, with a label "enter your email"

2. a drop down box, with a label "labeled select city"

The labels are to appear inside the form input field before the user types any data.

The form is to have a title "register to receive daily deals via email"

The form is to sit in a div box that should be styled to fit in with the website.

The form must be visually appealing and fit in with the webpage.

The form should submit a "$_POST" or $_GET array to another page. This array should contain value email="$inputed_email" and city="$inputed_city"

Skills: Electronic Forms, Graphic Design, HTML, PHP, Website Design

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About the Employer:
( 10 reviews ) chippendale, Australia

Project ID: #1090233

Awarded to:


I can do this work. Thanks, Suresh

$35 USD in 0 days
(892 Reviews)

7 freelancers are bidding on average $43 for this job


Hi Have Gone through your requirement and understood, we are very sure that we can do your needs with your entire satisfaction. We have left a PMB for you plz feel free to have a look over there. Thnx Ram Webzin I More

$75 USD in 1 day
(98 Reviews)

HI, let start Now

$60 USD in 1 day
(142 Reviews)

Ready to get started

$30 USD in 0 days
(119 Reviews)

Please check PMB for details. Thank you

$35 USD in 1 day
(47 Reviews)

Dear sir,I'm willing to do this job for [url removed, login to view] you

$30 USD in 2 days
(0 Reviews)

Im ready for this. Check PM.

$35 USD in 1 day
(0 Reviews)