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HTML contact form coding

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: #4108691

7 freelancers are bidding on average $69 for this job

toinnisfree

quick pro help. ftp and escrow required.

$85 USD dalam sehari
(539 Ulasan)
7.9
k1ng440

Full time freelance web developer with over 8 years of commercial experience.

$100 USD dalam 2 hari
(97 Ulasan)
6.5
gopasoft

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

$70 USD dalam 2 hari
(27 Ulasan)
4.6
vw1880582vw

I am an experienced software developer and have 17 years experience working with the technologies you require.

$30 USD dalam sehari
(6 Ulasan)
4.1
kolnstyle

I've built quite a few contact forms before and I can get this done in a day.

$80 USD dalam sehari
(9 Ulasan)
3.4
simonoop

Hi! I'm more than qualified to code a contact form like the one you described. I'm sending you a PM with some more info, etc. Cheers.

$80 USD dalam sehari
(3 Ulasan)
3.0
lechatre662003

Very easy! I am available to start immediately.

$35 USD dalam sehari
(3 Ulasan)
1.6