In Progress

add a form to this page

Real quickie, I need a form added to the bottom right of the main image on this page:

[url removed, login to view]

The data from he form is then to be entered into a database.

I need the form to have the following:

1. Your name

2. Company name

3. email address

4. Contact phone

and a send button of course.

image attached on roughly where the form needs to go.

Skills: PHP

See more: email add, send form email address, form image, send page, add address, send form, add image, form contact, php page address, php data form, contact email form, contact form database, image form, phone add, real page, send form data database, add company name, add company, form send email, company name address database, form php page, form image php, attached page, send image phone, send image email php

About the Employer:
( 37 reviews ) portsmouth, United Kingdom

Project ID: #548441

Awarded to:

LloydesignStudio

Hi lets start. thank you. Lloyd

$30 USD in 1 day
(160 Reviews)
6.3

19 freelancers are bidding on average $33 for this job

sristerweb

Let me start.

$35 USD in 0 days
(276 Reviews)
8.1
jexplorer

Please check pMB.. jexplorer

$30 USD in 0 days
(164 Reviews)
7.1
DesignSolutionSW

Please check PM.Thanks.

$30 USD in 0 days
(63 Reviews)
7.0
dagdya99

Lets start

$30 USD in 1 day
(162 Reviews)
6.8
techcity

Please view PMB for details. Thanks.

$45 USD in 1 day
(26 Reviews)
6.7
jsinfoway

Lets get it done.. Thnx JSI Team

$45 USD in 1 day
(72 Reviews)
6.6
inspirad

Hi, I am interested. Please select me as your service provider. Regards, Inspirad

$45 USD in 1 day
(68 Reviews)
6.2
barca2045

I can do it really quickly

$30 USD in 0 days
(52 Reviews)
5.5
kingyond

please check PMB.

$31 USD in 1 day
(9 Reviews)
5.3
offacc

Please check PM for details.

$30 USD in 1 day
(45 Reviews)
5.1
sat12345

Plz check PMB..

$30 USD in 1 day
(51 Reviews)
3.9
sas05

sir please check the PM.

$30 USD in 0 days
(10 Reviews)
3.3
rehaanron4u

Ready to start :)

$30 USD in 0 days
(19 Reviews)
3.2
cheapndbest

I am ready please check PMB,Thanks

$30 USD in 1 day
(3 Reviews)
2.2
BestForever

I can do it. please select my bid. thanks

$30 USD in 1 day
(2 Reviews)
1.9
progressiveway

Ready to start, please check PMB for more detalis.

$30 USD in 1 day
(1 Review)
1.4
uniquelogics

HI, I am ready to finish it in one hour. thanks

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

ready to start...

$30 USD in 1 day
(0 Reviews)
0.0