In Progress

I need info form for website

Hello, I will need info form page with next details:

First Name __________________

Last Name __________________

Social Number _________________

Pin Code ___3 numbers__

Expire account (here I need month and year selector)

Zip Postal Code _______________

Country_________________

Email_________________

Complete action button, and after they hit complete button will recieve a message that their records was recorded.

I will need this infos to recieve on my mail on every signup to this.

Please add all this details in a nice div design, not more than 800px width and a big nice font, I will add after on my website.

Waiting for your bids!

Skills: CSS, HTML, PHP, Website Design, WordPress

See more: website design request form, web design client questionnaire form, website development form, website design form template, web design request form template, web form design templates, web design order form, web design form for client, I need a responsive website, i need a professional website build for my business i offer outsourcing solutions for foreigners, I need a new website, i need a new website psd to html, i need a new website i need you to design and build a landing page want a simple landing page with a, i need a new website i need you to design and build a landing page want a simple landing page with a image of a complete facenec, i need a new website i need you to design and build a landing page want a simple landing page with a image of a complete face(ne

About the Employer:
( 31 reviews ) Bucuresti, Guernsey

Project ID: #15694680

Awarded to:

J0k3RBiH

This is for me a lakh job. I can work for you very quickly. I have an excuse in programming for more than 7 years. I hope we cooperate. Contact me on chat

$35 USD in 1 day
(76 Reviews)
6.0

75 freelancers are bidding on average $119 for this job

rinsadsl

Hi there I am interested in doing this project where we will design a nice form where you will enter the details and submit. It will get saved in the db and a confirmation will popup. Looking forward to working with More

$84 USD in 2 days
(928 Reviews)
8.6
inspirad

Hi, I am interested in this form configuration project. I checked your details and understand your requirements. I am ready to start. Possible to add a good design for this form. Thanks Shibu

$79 USD in 1 day
(685 Reviews)
8.2
tretanz

Hi, We have a team of designer and developer who will work as per your requirement and finish in your deadline. We are TOP rated in the Freelancer and believe in the quality of work. We are an expert in Landing More

$157 USD in 3 days
(493 Reviews)
8.3
bestworkontime9

Hi, I have gone through with your requirements and I have exact match skills as the current project. I am an experienced web developer and ready to build a nice, clean and responsive design form for your website More

$103 USD in 3 days
(225 Reviews)
7.6
raoasghar

Hey there! i see its just like form development when user's fill the form and you will receive all user's into into specific address . Let me know if we can start this job please Thanks

$250 USD in 2 days
(280 Reviews)
7.4
Rahulkeshwani19

Hello sir, I can design and create a info form for you according to your given requirement and make it perfect. have experienced in this kind of job. recent work:- [url removed, login to view]

$50 USD in 3 days
(123 Reviews)
7.1
sdinfoways

HI, we will design and code the form , you will receive all filled info in your email upon submissions. -will deliver 100% mobile responsive page. =[url removed, login to view] =[url removed, login to view] =https:/ More

$111 USD in 2 days
(220 Reviews)
7.3
JamesTechnology

Hello there, i checked your requirement that you need info form page. I checked the all point as well. I am ready to discuss with you. please DM me. thanks

$222 USD in 10 days
(175 Reviews)
7.0
riteshjain009

//** READY TO START RIGHT AWAY AND PROVIDE YOU WITH IN NEXT 24 HOURS AS PER YOUR NEED **// Hello Sir / Mam, Greetings, Thank you for giving us opportunity to send our proposal on your project. I have gone throug More

$150 USD in 2 days
(259 Reviews)
7.2
forcitCample

Hi There, I can help you build an info form for website according to your requirements mentioned in job brief.I have loads of experience with WordPress which is an ideal scenario to get your job done with [url removed, login to view] wo More

$250 USD in 3 days
(114 Reviews)
6.9
$155 USD in 3 days
(116 Reviews)
6.7
mondersky

I've seen the form structure and I am ready to buil you a fresh new modern and user friendly form with fields validation and storage to database + confirmation message and email sent to you. I think I am the right free More

$100 USD in 3 days
(189 Reviews)
6.8
BizzCreator

Hello sir we are professional designer and developer we are expert in WordPress html etc you can visit my portfolio we complete your project within 6 business days please come on chat we can discuss. some recent wor More

$277 USD in 3 days
(85 Reviews)
6.8
$155 USD in 3 days
(97 Reviews)
6.4
vuyiswankosi

Hello. I can complete the format you've described in 3+ hours. Is it just the form being emailed to you and then a confirmation for the user?

$35 USD in 1 day
(32 Reviews)
6.7
webarox

Hi, We are highly skilled and talented developers. We design custom design and development as per client requirement. We have made many websites. Here are few links: [url removed, login to view] [url removed, login to view] ww More

$166 USD in 3 days
(90 Reviews)
6.4
Ripper1

Hello i can create you form like that with html,css+php for function i will need few hours to make it look good but i am sure you will be happy and it will be easy for you to integrate it regards

$50 USD in 2 days
(83 Reviews)
6.1
mfali420

Hi, i can do this right now and i can do this in 25$, I'll complete this form as your requirement within next few hours some of my recent work [url removed, login to view] [url removed, login to view] More

$30 USD in 0 days
(67 Reviews)
6.2
expertonphp

Hello Sir, My name is Mohit and I understand your project requirement carefully. I will create a nice form using bootstrap framework so it will be responsive too for small devices. Also, will validate before submit More

$30 USD in 1 day
(129 Reviews)
6.5
ravichedwal

Hello Sir, I have vast experience of web development & designing have developed many websites with client satisfaction have developed many websites & also have done form submission process. Once you chat with More

$155 USD in 3 days
(70 Reviews)
6.3