In Progress

User Input Module

I have a website similar [url removed, login to view]

On the front page of the above website, there is a user input module requesting user name, medical insurance, phone number... etc.

I need the exact same module that emails the content to my email address and is also recorded in a database.

Skills: PHP

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About the Employer:
( 128 reviews ) Bala cynwyd, United States

Project ID: #15165442

Awarded to:

gowtham15

A proposal has not yet been provided

$30 USD in 2 days
(0 Reviews)
0.0

29 freelancers are bidding on average $160 for this job

hits

We have coded similar forms to save data, send as email for many sites. I am confident of delivering well. Pls share site url where this needs to be added,validations needed, values for dropdown lists Relevant Skills More

$126 USD in 2 days
(929 Reviews)
8.9
extreamcode

HI Sir/Madam, I can assist you with "User Input Module", I have experience working with "similar Development". Let's have a quick chat to discuss it further. Relevant Skills and Experience I have been in this "Develo More

$155 USD in 3 days
(60 Reviews)
7.4
NickolaS

HI, I can make this form for user details within a day Соответствующие навыки и опыт 12 years PHP Предлагаемые промежуточные платежи $100 USD - full escrow

$100 USD in 1 day
(340 Reviews)
7.5
webXpart

Hi, I checked your project details and checked the example site. I understand your requirement and i confident on it. Please come online and give me your site link so i can check and start working. Please check m More

$66 USD in 3 days
(49 Reviews)
6.6
$243 USD in 10 days
(77 Reviews)
6.3
BizzCreator

Hi, We are a team of professional web designer/developer, we are experts in Wordpress, Joomla, Ecommerce, Shopify, PHP, MySql, Responsive, Bootstrap, HTML 5 / CSS3, Landing page, PSD to HTML and etc. Relevant Skills More

$155 USD in 3 days
(45 Reviews)
6.0
anamaria1979

have a website similar [url removed, login to view] On the front page of the above website, there is a user input module requesting user name, medical insurance, phone number... etc. I need the exact same module More

$100 USD in 0 days
(142 Reviews)
6.5
infowider11

Hello,I m a Web and App Developer cum designer with 7 years' of exp.I just go through your requirement, i m showing interest in your project bcoz i m doing same type of job , i can show you demo Relevant Skills and E More

$555 USD in 15 days
(42 Reviews)
6.0
shafayat671

Hi, I can make your emai content. It will take 3 days and my budget is $155. Pls ping me for more discussion. Thanks, Shafayat. Portfolio: [url removed, login to view] Relevant Skills and Experience Language: PHP, HTML, CSS, My More

$155 USD in 3 days
(47 Reviews)
5.7
XpertSolNet

Hi, I have already developed many websites and very much proficient in starting this project with you according to all your specifications. Wasi Relevant Skills and Experience [url removed, login to view] http://fridaypos. More

$250 USD in 3 days
(21 Reviews)
5.5
vismat

I have read your job description very carefully and understood that you require an web developer. Relevant Skills and Experience I have more than 6+years’ experience in Web Design & development Like WordPress, Woocomm More

$166 USD in 3 days
(16 Reviews)
5.4
ruwanjayawardena

Hi..Have a Good Day, Pls Contact me via freelancer chat.I need to discuss more about your project requirement in detail. I'm standalone custom php developer. Thank you. Relevant Skills and Experience # Proposed Miles More

$155 USD in 3 days
(25 Reviews)
5.7
brianconey

HI there? As a highly skilled PHP Web Developer, I read your posting for a new PHP Web Developer with interest. So I am sure I can accomplish your project. With more than 8 years’ experience as a PHP Web Developer, More

$155 USD in 3 days
(39 Reviews)
5.6
wsafreelancer

HI! I m interested to make follow website user inpput modules etc as you mention in project descriptions once contact me i will start work immedialtey and complete it as your requirement Relevant Skills and Experienc More

$150 USD in 3 days
(71 Reviews)
5.4
saritamahar

Hello, I reviewed your reference site and I assure that I can create an exactly same module on your website. I can complete that work within 2 days. Please enable the chat for further details. Relevant Skills and Expe More

$100 USD in 2 days
(31 Reviews)
4.7
chnabeel002

Dear Sir, We have evaluated the project in detail and we came up with a proposal that is appropriate for your needs. With our aim to help you achieve your project’s goal. Thanks. Relevant Skills and Experience PHP, More

$155 USD in 3 days
(17 Reviews)
4.4
rockstardev3

Hi. I have reviewed your project and can do your job within 3 days. I will show good skills. Relevant Skills and Experience php Proposed Milestones $155 USD - one time.

$155 USD in 3 days
(14 Reviews)
4.2
$155 USD in 3 days
(12 Reviews)
4.2
Rekhathakur

I gone through website [url removed, login to view] I completely understood your requirement I have already designed and developed many Website with required functionality and features can start now. Relevant Skills a More

$155 USD in 3 days
(4 Reviews)
4.1
JinYongbin

I have a lot of experience in development of project like what you want. If you hire me, I will do my best to develop your project wonderfully in a short time! Relevant Skills and Experience I have more than 5 years More

$155 USD in 3 days
(3 Reviews)
3.8