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HTML contact form coding - repost

I am developing a new website geared toward collecting new subscribers. I need someone to code the contact form (so I can use it on any website in the future). The form should send the new subscribed information to a database. The form must collect the originating IP address from which the person filled out the form and also include the following fields:

Email

First Name

Last Name

Address

City

Zip Code

Phone

Should be a simple enough job for someone...

Kemahiran: Reka Bentuk Grafik, HTML, MySQL, PHP

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Tentang Majikan:
( 4 ulasan ) Commack, United States

ID Projek: #4108753

Dianugerahkan kepada:

NeOLiO

Hi, I can deliver form to database code with ip address capturing. Please check PMB. for complete details. Thanks.

$30 USD dalam sehari
(91 Ulasan)
6.7

44 pekerja bebas membida secara purata $42 untuk pekerjaan ini

naumanrandhawa

Perfect man for this job.

$50 USD dalam sehari
(147 Ulasan)
7.1
freeworks

Hi, I saw your project description. I will do that on time. I will do custom design and coding for you. Please check my profile and portfolio. Thanks

$30 USD dalam 0 hari
(139 Ulasan)
6.8
royind

Ready to start. Thanks.

$30 USD dalam sehari
(43 Ulasan)
6.7
ssahilsl

We have really experienced in web design and development, Graphic Design and Landing page Design, Logo, Banner, Brochure, HTML, XHTML, [url removed, login to view] open message board for previous results and let's award us. Regards Di Lagi

$30 USD dalam sehari
(96 Ulasan)
6.7
stevebryant

Hi, I can work that form. Ready to start. Regards, Steve

$30 USD dalam sehari
(432 Ulasan)
6.5
nbcrony

Let start.

$30 USD dalam sehari
(31 Ulasan)
6.1
sinisa

Hello, can be done very fast.

$40 USD dalam sehari
(101 Ulasan)
6.1
udanaudayanga

Hi, Can code the subscription form as you can use it any where. Just few hours work.

$30 USD dalam 0 hari
(47 Ulasan)
5.7
samzinc

Kindly check your pmb

$120 USD dalam sehari
(47 Ulasan)
5.7
andrespa

Clear with requirements and ready to start. Thank you.

$60 USD dalam sehari
(31 Ulasan)
5.6
csajit

LETS DO IT!!!

$30 USD dalam 0 hari
(122 Ulasan)
5.5
jcodemasters

Hello, can do it in a day.

$75 USD dalam sehari
(46 Ulasan)
5.5
tomstat123

experienced developer. I have done similar form. I can do this.

$50 USD dalam sehari
(30 Ulasan)
5.5
burtzerk

I can have this done in an hour if you grant the project to me.

$50 USD dalam sehari
(25 Ulasan)
5.4
callumbwhyte

I have just finished two very similar projects on here and I'll do this within a few hours!

$30 USD dalam sehari
(34 Ulasan)
5.3
Softanz

Professional developer here. I am 6+ years experience in HTML, PHP5, CSS ,MySQL, Ajax, Jquery, JavaScript, Wordpress. My portfolio and review will clarify my skills.I can quickly help you to get it done on-time and wit Lagi

$30 USD dalam 0 hari
(35 Ulasan)
5.2
Tharawen

Hi, please see PM for details

$30 USD dalam 0 hari
(39 Ulasan)
5.0
milenhristov

Hello, I'm software developer with over 11 years experience with PHP, MySQL, JavaScript, HTML, CSS. Please see my profile/resume for more details. I can finish the task in next few hours. Best Regards, Milen

$35 USD dalam sehari
(18 Ulasan)
5.0
gopasoft

Hi, I would like to start this project ASAP. Please check your inbox for more details. Thank you!

$34 USD dalam sehari
(27 Ulasan)
4.6
tooltor

Ready to start here, I will build the forms according to the design of your website and will save the information into your database and with a copy into your email. Please check the private message.

$50 USD dalam 0 hari
(36 Ulasan)
4.6