Contact Form with Captcha

See attached pre-made form. I'd like you to make it work =)

The person filling out the form should be required to enter captcha data that is verified before the form is sent. Name, email & phone must be required pieces of information. If the person does not enter the captcha data or enters it incorrectly OR if they do not enter their name, email & phone, an error message should be displayed. I'd like it be easy for me to change the error messages. I would like three error messages: one for incorrect captcha, one for missing captcha and one for missing name, email or phone.

Once the captcha data has verified and the name, email & phone have all been confirmed present, the information from the form should email to an address I'm able to specify in the code.

The email sent to the specified email address should be formatted in an easy to read format such as . . .

I am interested in the following services:

Breast Augmentation, Lift, Reduction

Laser Hair Removal

General Consultation

I heard about you from: a Referral

Name: Their Name

Email: Their email address

Phone: Their Tel #

I hope that's enough example :)

See attached form as your guideline for the email. The exact form attached should be used as the display HTML. Also, I would prefer that the page refresh the least amount of times as possible. So, the person submits the form, the page refreshes to the "Thank you" text. And that's it. Please no external mail send file. I'd like it to be all contained at the top of the file unless you can tell me a really good reason of why not to do it that way =)

Skills: PHP

See more: thank you messages, please tel me, incorrect from address, incorrect email address, html code for contact form to email, enter your email address in the format, email incorrect, email address is incorrect, contact at once, captcha error message, captcha code php, three form, LIFT, laser, enter captcha, data removal, Captcha Data, breast, captcha referral, html mail form, form mail php, html form send mail, change refresh, send form email address, form data filling

About the Employer:
( 89 reviews ) Dubai, United Arab Emirates

Project ID: #583912

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