One page editable signup submission form

I need a form created containing different fields and 1 recipient . I need to easily be able to change the recipient of the form. Not PHP form. I would prefer only having to use one form that can I can replicate and edit the recipient in the code from this one page form.


Title: Order Request Form

Text On Top of Form: Please complete this form so that we can setup your new website. You will receive an email shortly so we can get started. We look forward to working with you soon.

Field 1: Full Name

Field 2: Contact Email

Field 3: PayPal Email

Field 4: Domain Name (1st Choice)

Field 5: Domain Name (2nd Choice- in case 1st choice not available)

Field 6: Special Instructions

email subject: New Order Request

I want every thing to be editable and I need to be able to duplicate this form for any of my resellers and replace the recipient email address easily on the one page form.

Need for it to look professional and have the ability to easily change the recipient email address.

I wait your bids.


Skills: HTML, MySQL, Website Design

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About the Employer:
( 7 reviews ) Cumming, United States

Project ID: #17978396

Awarded to:


Hello Joel, i'am very good at webfroms and i can create you a script that generate a from and you can edit it when ever you want and change the recipient very easly... If the project is fairly paid I can build you a sm More

$45 USD in 1 day
(30 Reviews)

26 freelancers are bidding on average $30 for this job


Hello I am a full service provider for corporate or individual interested in designing their design & development needs of web based projects. We are experts in HTML,CSS,Boostrap,Jquery,Javascript,core Php, Magent More

$25 USD in 1 day
(235 Reviews)

Note: Yes Milestone will be released when work done. I have great working experience with Designing & developing. I'll give you update after every 2 hours during project. We have worked on many projects and complete More

$35 USD in 1 day
(197 Reviews)

Hello there, As per my understanding you need a form created containing different fields and 1 recipient .We have 7+year experience in website design and developments in E-commerce,Woo-commerce, Javascript,PHP, WordP More

$35 USD in 1 day
(168 Reviews)

I have experience of Website in PHP, Laravel, CodeIgnitor, Wordpress, Opencart, Woocommerce, Photoshop, Adobe Illustrator . We also have experience of making Android,Window and iphone application with ionic & phonegap. More

$19 USD in 1 day
(95 Reviews)

Hello, Hope you will be doing well!! Given my background in Website solutions and talent for creating aesthetically pleasing and highly functional website, I have read your description and I understand your re More

$40 USD in 1 day
(69 Reviews)

Hello How are you? I am very interested in your project. I have read your description very carefully. I can do your job in time. I would like to talk with you in detail about your project. Kind More

$25 USD in 1 day
(30 Reviews)

Hello, I have gone through your project description and understand your Form requirement, Please award me I can deliver this within a day. My Recent Work portfolio links : [login to view URL] http://www.10s More

$30 USD in 1 day
(26 Reviews)

Hi there, Greetings from TechPlus! I've reviewed requirements & ready to develop editable form as we have 5+ years experience in web development. Our Expertise: CMS (Wordpress, Magento, Shopify, OpenCart, Joo More

$100 USD in 3 days
(51 Reviews)

I have experience creating websites / applications on unity,wordpress, oscommerce, html, html5, opencart, prestashop,, PHP, joomla, drupal and many other languages and CMS. - 5+ years experience creating web More

$30 USD in 1 day
(12 Reviews)

Hi, I would love to work on your project. Our teams have experienced developers with a powerful track record and real talents for developing the needs of our client. We have developed multiples iOS and Android More

$10 USD in 1 day
(40 Reviews)

I have vast experience in HTML, CSS, BOOTSTRAP, Php, Mysql, and jQuery web Development, Wordpress and Google App I can write Javascript & Php script for you. I'll fix your all CSS or HTML errors, or layout problems o More

$18 USD in 1 day
(25 Reviews)

Hi , We will help you to One page editable signup submission form as per your details. and also we will provide you the unlimited revisions until you do not satisfy. Let's connect

$40 USD in 1 day
(9 Reviews)

Dear Joel, I would like to discuss few thing for better understanding of [login to view URL] share details and ping me for further discussion. Spare a moment on our previous work [login to view URL] http://profeenlinea More

$25 USD in 1 day
(9 Reviews)

Dear Hiring Manager, I have seen your requirements carefully and as per my previous experience I can do this project for you. I have extensive experience in PHP,Codigniter,Word Press, MVC,OpenCart,Bootstrapping. Based More

$25 USD in 1 day
(9 Reviews)

Hi, Greetings of the day!! Thanks for review my Bid. I have 10+ year experience in PHP and 6+ experience in Wordpress. I have strong knowledge of Wordpress as i have completed many projects in this. Please rev More

$20 USD in 1 day
(11 Reviews)

I am a website developer. Offering services to our diverse client across the world. Sign Up Form Landing Page ☛ Registration Form Landing Page ☛ Event Form Landing Page ☛ Product Base Landing Page ☛ App Landing More

$20 USD in 1 day
(12 Reviews)

Hopes you are doing great:) Welcome to #1 Graphic Design Company on Freelancer we offer: 1. Multiple Designs 2. Unlimited revisions 3. Great Customer Services 4. 100% Satisfaction results We never compro More

$30 USD in 1 day
(14 Reviews)

Hello sir, I am expert developer and designer. I can create this form for you in responsive HTML. I can assure you that if you work with me once, you will always work with me for these kind of projects. Looking forwar More

$10 USD in 1 day
(10 Reviews)
$15 USD in 1 day
(11 Reviews)

Hi Joel, I am ready to develop a form that containing different fields and 1 recipient as per your given requirement. I am a web developer and very much famuiliar with HTML/CSS, MYSQL, WordPress and PHP. I am ready t More

$25 USD in 1 day
(1 Review)