Single Page Form for an already existing website.

I have a website already working. I need to add a form like the one attached that can be filled out by the person viewing the website. Fields are limited to the amount of characters. When the person filling out the form completes the form, there should be a send button. When he presses sends him a copy of what he just filled out and also send an editable file with the name of the file being "the zip code he filled out"+"the first four characters of his email address" to a specific email address that I will give to the person awarded this job. Also, there are three fields. Open Mic, PTT and RX Only to the right of the User. These should be radio buttons. Only 1 of those can be checked per users. Also, there can only be a maximum of 12 "Open Mic" So, if the user tried to make a 13th Open Mic, a message box would pop up alerting him that he has reached his limit of 12.

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

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About the Employer:
( 3 reviews ) LOWER BURRELL, United States

Project ID: #17002682

22 freelancers are bidding on average $26 for this job


Hello There, How are you? I hope you are having great time in your life. I am having more than five years of experience in wordpress. I have seen the form you had attached and I can make it. I will apply al More

$25 USD in 1 day
(257 Reviews)

We are committed, honest, and reliable, and We try our best to provide customized designs and quick responses. We will provide you daily update.--- You can check out our recent project [login to view URL] - More

$15 USD in 1 day
(168 Reviews)

HI there I have gone through your project details, i can do that job easily. I have developed many skills so far. In languages and open sourse softwares. Front-end :javascript ,jquery,bootstrap,sass,compass,node.js More

$35 USD in 3 days
(124 Reviews)

Hello, Greetings from Rehan Arshad :) I will definitely add Single Page Form to an already existing website as per your requirements. I am expert in Developing and Designing for a website with great experience More

$35 USD in 1 day
(72 Reviews)

Hello I'm quite known for completing websites under a given deadline and that too with maximum quality!! I am interested and ready to create Single Page Form for an already existing website. Here is my WordPr More

$40 USD in 1 day
(48 Reviews)

Hello Sir, I have read your job very carefully and analyzed all the details. I request you to please go through my Portfolio. It will give you the brief idea of my work. My selected previous work as follows: More

$25 USD in 2 days
(18 Reviews)
$25 USD in 1 day
(16 Reviews)

Hello! Nice to meet you. I have read your project carefully and what I want is, I will complete it more professionally. I have rich experience with web development! Have more than 5 years experience with Front-en More

$25 USD in 1 day
(28 Reviews)

Hey, Hope you are doing great…!!! I just read your requirements. i have around 6 years of experience in the Unity3d / Android / IOS / AR / VR Development. i understood your requirements and i am able work More

$25 USD in 1 day
(1 Review)

A proposal has not yet been provided

$55 USD in 3 days
(9 Reviews)
$10 USD in 1 day
(6 Reviews)

Hello, I am very much interested on your project.I feel that I am the exact match for your requirements after thoroughly reviewing the job description and desired skills. Thanks

$25 USD in 1 day
(1 Review)

Hello ! I am working on several websites. I can create a ecommerce or personal or professional website at lowest cost. you can hire me to add payment gateway,SSL certificate, SEO etc. to see my works visit my profile. More

$25 USD in 1 day
(2 Reviews)

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$25 USD in 7 days
(0 Reviews)

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$25 USD in 5 days
(0 Reviews)

Hi there, I have lots of experience in web development and WordPress development and would really like to help you with this. Please let me know if you are interested.

$25 USD in 4 days
(0 Reviews)

I am A full stack developer with plenty of experience in this field. Worked on similar projects before. I am confident about this project.

$25 USD in 1 day
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$10 USD in 1 day
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Hi my name is Christopher, I am a 1099 employed project manager. I have managed projects worth over thousands of dollars. Please message me the details and we can begin asap.

$25 USD in 1 day
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Hi, I check your project details & i can do it. I interest your project. 100% clean code & client satisfaction work. I have almost 4+ years of total experience in Web Design & Development with knowledge of PHP, M More

$25 USD in 3 days
(0 Reviews)