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simple form and mysql database

I have a form that needs to post into a database. Attached is a mockup of the fields needed. Once completed I'll need to be able to upload the database into my own.

Kemahiran: Borang Elektronik, MySQL, PHP

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Tentang Majikan:
( 84 ulasan ) Mystic, United States

ID Projek: #1574928

Dianugerahkan kepada:

ExcellenceonPHP

Checked the form [url removed, login to view] [url removed, login to view]

$30 USD dalam sehari
(132 Ulasan)
6.6

10 pekerja bebas membida secara purata $55 untuk pekerjaan ini

waelfree

Hi, I can do that

$30 USD dalam sehari
(97 Ulasan)
6.9
ansi2

Proposal details wull follow. Thanks, 2ansi

$30 USD dalam sehari
(89 Ulasan)
6.3
AdamsK

Ready for service sir, thanks.

$30 USD dalam sehari
(77 Ulasan)
5.6
easycoders

Ready to do the job. PM if you are interested.

$40 USD dalam 2 hari
(38 Ulasan)
5.4
nobelsolution

Hi, I am ready to start it.

$30 USD dalam 0 hari
(12 Ulasan)
4.2
amieshaiful

please check your pmb

$30 USD dalam sehari
(12 Ulasan)
3.8
Kamranahsan

I will make your database in one days.

$30 USD dalam sehari
(1 Ulasan)
0.7
Jerryinfotech

PLEASE CHECK PMB

$150 USD dalam 3 hari
(0 Ulasan)
0.0
Josefinfotech

PLEASE CHECK PMB

$150 USD dalam 3 hari
(0 Ulasan)
0.0