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Website Contact Form

I need a contact form for my website, my website is run on a Linux server, so I prefer code to be PHP...

The form requires these fields:

First Name

Last Name

Date of Birth

Contact Number

Email Address

Expected Compensation


The Date of Birth field should use an AJAX or JavaScript type calendar, always defaulting to 18 years and 1 month ago

The Photographs should be able to be dragged and dropped on to the form with AJAX or something

The form, possibly with multiple photo attachments, should be emailed to me, showing me all of the information and picture attachments

I need this to work for the most common browsers, IE, Firefox, Chrome, Safari, etc.

The form should be safe from hackers as well

Kemahiran: AJAX, HTML, Javascript, PHP

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Tentang Majikan:
( 9 ulasan ) Pevely, United States

ID Projek: #1559250

Dianugerahkan kepada:


Hello, I may do the task, check your PM please. Thanks, Alex

$150 USD dalam sehari
(36 Ulasan)

7 pekerja bebas membida secara purata $104 untuk pekerjaan ini


Details in PMB

$60 USD dalam 0 hari
(217 Ulasan)

Lets do it now..thanks

$120 USD dalam 2 hari
(129 Ulasan)

Ready to start now! please check pmb

$200 USD dalam 2 hari
(40 Ulasan)

............ Give you the service beyond your expectations...please check PMB....... . Thanks.

$100 USD dalam sehari
(36 Ulasan)

Please see PMB. Thank you

$50 USD dalam sehari
(0 Ulasan)

Hi Check Private Message.

$49 USD dalam sehari
(0 Ulasan)