In Progress

PHP mail form

Need php form that can fit in a wordpress blog.

This form will be placed in wordpress default blog page.

Need project done fast

I will need the following information for the form.

-----contact information-----

Name

address

phone

email

-----mortgage information----

purchase price

year purchased

Is this your primary residence?

1st mortgage amount

2nd mortgage amount

3rd mortgage amount

Are you behind on payments?

If yes, how many months?

----Questions/Concerns

(make this a box for them to type)

----Tell us a little about your situation----

(make this a box to type)

**Your information is kept completely confidential. This is a simple inquiry form so that we can better understand your situation. You can always call us at 949-363-5055 if you would prefer.

Also need a small php form and pop up with javascript with no buttons/bars or anything on pop up.

I will need the following for this form.

How did you hear about us?

(drop down box with)

- Magazine

- Internet/Search Enngine

- Direct Mail

- Other ___________ (type box_

Skills: PHP

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About the Employer:
( 32 reviews ) Valrico, United States

Project ID: #209734