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Need Custom Form Built Asap

I need a form built for my website similar to this one...

[url removed, login to view]

(screenshots are also attached)

and depending on what the answers are, a check mark (see attachment) shows up next to the topic on the confirmation page.

Kemahiran: Javascript, PHP, Memasang Skrip, Reka Bentuk Laman Web

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Tentang Majikan:
( 113 ulasan ) Grand Rapids, United States

ID Projek: #370340