In Progress

PHP Contact Form

I require the attached graphic turning into a completed form (today). Font used is century gothic and the 'please choose' is a drop down menu.

Skills: PHP

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About the Employer:
( 38 reviews ) Gainsborough, United Kingdom

Project ID: #544629

Awarded to:

nukecoder

Can be done today.. Let's start. Thanks

$35 USD in 0 days
(14 Reviews)
4.0

15 freelancers are bidding on average $40 for this job

natgeo

Please see PM. Thanks

$30 USD in 0 days
(108 Reviews)
6.9
inspirad

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

$40 USD in 0 days
(77 Reviews)
6.4
LloydesignStudio

Ready to begin. waiting for your selection. Thanks. Lloyd

$50 USD in 1 day
(170 Reviews)
6.3
ichurakov

Please check PM. Thnx.

$35 USD in 0 days
(215 Reviews)
6.3
dinhtoan

Hello! i'm Toan i'm expert with design, php code, php , php opensource ( joomla,woodpress,opendCart,Zencart,Magento,payment setting)framework(codeIgniter,cakephp) psd xhtml, css validate with w3c, javascript, jquery js More

$40 USD in 0 days
(58 Reviews)
6.2
efflux

Will be done in 3-4 hrs max.

$100 USD in 0 days
(42 Reviews)
6.0
exitsol

Pls see PM for more details

$30 USD in 0 days
(107 Reviews)
5.8
thomasbill

UK provider at your service.

$30 USD in 1 day
(24 Reviews)
5.8
ezee

Hi there, WE are ready to start Right now and We would be glad in accomplishing your work based on your requirement. It would be our pleasure to work with you and start a fruit full relation at both the end. I request More

$30 USD in 1 day
(41 Reviews)
5.6
CoderTech

very simple work, assuming the dropbox is static. if you want me to get the data from ajax that is more costly. thanks.

$30 USD in 0 days
(7 Reviews)
4.7
Thewebweavers

Hi, Ready to provide you full and extended support within ur time frame. Lokking forward you in my PMB.

$30 USD in 0 days
(15 Reviews)
4.0
webcomin

Hi, Ready to [url removed, login to view] PM

$30 USD in 0 days
(6 Reviews)
3.8
developer84

Hi, Check Your PM [url removed, login to view]

$30 USD in 0 days
(5 Reviews)
2.0
rxsuman

Hi, Let's start. Please check PMB. Thanks

$50 USD in 1 day
(2 Reviews)
0.0
ssssss1

interested

$35 USD in 0 days
(0 Reviews)
0.0