Build HTML Form

Looking for a developer who can write HTML, CSS and JavaScript.

Need an HTML form designed with the following requirements.

1 - Header

3 - Sub Headers (1 Hidden)

5 - Text input fields (2 fields are required and need verification before submission. 3 read only)

1 - Text area field

1 - Check box (If the box is checked, a text area should appear below to prompt for comments. User cannot submit form if checkbox is checked but the text area is blank)

3 - Check box's that correlate to 3 of the text input fields (If checkbox is checked, user must enter text in the input field. User cannot submit form if checkbox is checked but the input field is blank)

6 - Check box's

1 - Save button (Should cause the validation to trigger)

1 - Cancel button (Should cancel form submission)

6 - Hidden read only text input fields

Other Requirements:

- Code should have comments

- The form should be modern and have nice CSS styling (Has to be Internet Explorer compatible)

- The form should be responsive, if the user shrinks the screen the form should shrink (Within reason)

I will provide even more details via email or direct message. This includes acceptable colors and the labels for input fields, etc.

Skills: CSS, HTML, HTML5, Javascript, PHP

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About the Employer:
( 3 reviews ) South Euclid, United States

Project ID: #16285118

Awarded to:


hi i can create responsive html form for you.i will do it within 2 [login to view URL] me message for start work. thank you.

$35 USD in 0 days
(44 Reviews)

43 freelancers are bidding on average $34 for this job


Hello Salienttemplates is a full service provider for corporate or individual interested in designing their design & development needs of web based projects. We are experts in HTML,CSS,Boostrap,Jquery,Javascript,c More

$35 USD in 1 day
(293 Reviews)

I will create the form and will include the instruction given on that. I can start your work right now. Regards Jasmine

$45 USD in 1 day
(183 Reviews)

I have read the requested requirements. I am highly interested to make the requested HTML page. I am a professional front end developer. I have more than 5 years experience. I will make sure the best quality service.

$50 USD in 2 days
(92 Reviews)

Dear Client Thank you for your job posting. I have much interesting in iour job. I have 8+ years experience in Front-End Development Particularly I am strong at HTML5/CSS3/BootStrap/Media Query(Mobile Responsive). More

$35 USD in 10 days
(101 Reviews)

A proposal has not yet been provided

$35 USD in 10 days
(40 Reviews)

I would be able to create the mobile responsive form you've specified. I'm proficient in html5, css3, js/jquery, php, mysql and I have extensive experience in website development and design.

$49 USD in 3 days
(68 Reviews)

Hi, I have read your job description. I can definitely do it. I can give you fully responsive website design. I have done many projects using Codeigniter, php, wordpress etc. I can give you the exact what you want.

$50 USD in 10 days
(71 Reviews)

Hello I have reviewed your job scope and I am confident to provide you a suitable solution. Please message to have a discussion on the project. Regards

$20 USD in 1 day
(48 Reviews)

Dear Sir/Madam, I have 7+ years Experience in Web-Design and Web-Development.I building different types of Web Site (Ecommerce,Classified,Realstate,Weding,Porn,Personal,Dating,Event Management...etc ). I reading More

$50 USD in 10 days
(94 Reviews)

Hi mate, I’d be glad to assist for web development . I have read description carefully understand requirement and planned to proceed with your requirement. I have 6+ years experience with web development. Proven exp More

$50 USD in 1 day
(61 Reviews)

Hello As a professional web developer, I have 8 years of experience with web development. I read your job description and I can complete your task perfectly. I am able to work right now. Regards Tong

$35 USD in 10 days
(31 Reviews)

sir,i have 5+ years experience in web-design and web-development,wordpress. I know responsive design , bootstrap framework , Html 5 , php.

$50 USD in 1 day
(92 Reviews)

Hello Sir/Madam, I can start the work right now. I'll also write validations for those fields using JQuery. I have 2+ years of experience in web development, SEO, Site optimization and maintenance services. T More

$25 USD in 1 day
(13 Reviews)

Thank you for visiting my cover letter. When I read your project, it really appeals my mind. I have rich knowledge about HTML, CSS, JAVA script, PHP, various Framework, I always regard client’s opinions very importan More

$25 USD in 10 days
(35 Reviews)

Hello Sir, hope you are fine, i am ready to Build HTML Form. kindly share more details and names of fields ?

$50 USD in 3 days
(40 Reviews)

sir, I am a passionate Web developer. My skills and experience range from html5,css3,bootstrap,javascript,jquery,sass,wordpress. I work with individual clients as well as with organization. Thanks Here is my work s More

$35 USD in 10 days
(45 Reviews)

Dear Hiring Manager, I am good at HTML. I've created many forms similar to this one so far. Please check my client's feedback. Now I am free and ready to start right away. Kind Regards, Md. Anisur Rahman

$50 USD in 1 day
(22 Reviews)

Hello, I am expertise in Angular Js,Node Js,PHP, Mysql, WordPress, Joomla, Magento,cake php, yii,yii2, codeigniter,Laravel,OpencartWeb design, Graphics design,Psd to Html,Responsive Website. some of my project link More

$45 USD in 1 day
(17 Reviews)

Hello I am very glad to let you know that I am interested to do your project. I am offering you the best services for the lowest budget. I am also giving 100% Satisfaction Guarantee. I also give one month free sup More

$40 USD in 3 days
(18 Reviews)

Hi, Hope you doing well.I read your project description and very confident to handle this project perfectly Let's have a discussion, negotiate costing, timeline and then we proceed Thanks!

$19 USD in 10 days
(28 Reviews)