Simple PHP/MySQL form

URGENT! 48H-72H...

We need a freelancer to make a web form (in PHP with MySQL) out of a paper form.

The paper version of the form is the attachment (the two last pages of the document). The final web form should have a similar disposition to the actuel form. We'll provide you the requiered fields. A validation should also be done on selected fields (phone number, webmail, etc.). There will also have some minor modifications to do (eg. add a "I understand that blab blah blah" cheekbox and a 200 words textfield).

We also are looking for an administration panel (with a password) where admins will be able to delete or modify entries. We will be able to show you exactly what we are looking for.

If you bid on this project, please have some realisations to show. You'll also need to be able to complete the job before or on saturday... You can use any PHP tools you want.

We are looking for someone who will be able to do a minimalist but good-looking CSS job. We will pay a bonus for a fast & clean job.

Thank you!

Kemahiran: CSS, HTML, Javascript, MySQL, PHP

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Tentang Majikan:
( 9 ulasan ) Joliette, Canada

ID Projek: #4115369

Dianugerahkan kepada:


hey :) please see PM

$150 CAD dalam 3 hari
(84 Ulasan)

10 pekerja bebas membida secara purata $133 untuk pekerjaan ini


Quality work assured. Ready to get started. Thanks.

$400 CAD dalam 2 hari
(414 Ulasan)

I have sent a private message to your inbox that contains my relevent skills and any questions I have.

$120 CAD dalam 0 hari
(181 Ulasan)

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

$120 CAD dalam 4 hari
(98 Ulasan)

We understand that we are new to freelancer but not in this industry. You can see our previous works in the inbox message and decide for yourself. You would have the best professional work possible. Look forward to dis Lagi

$120 CAD dalam 2 hari
(17 Ulasan)

Hi, We can build you the web form exactly as per your requirement . Have sent you more details about the project via PMB .

$120 CAD dalam 2 hari
(10 Ulasan)

Hi, I'm interested that projects - please check PM for more details.

$250 CAD dalam 2 hari
(10 Ulasan)

ready to start job now. thanks

$50 CAD dalam 0 hari
(7 Ulasan)

Have a kind at PM.

$100 CAD dalam 2 hari
(8 Ulasan)

I have built many forms using Ajax, creating a clean form submission. I can have this done for you fast.

$100 CAD dalam 2 hari
(0 Ulasan)

Hello I have a elegant and efficient design as per your requirements

$50 CAD dalam 2 hari
(0 Ulasan)