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Service Quote Form Based on Zip code+

I need a simple tool created that can be embedded into other websites easily (think link bait), that will cause a link to be created with the anchor text, "notary". The tool will be a simple fee quote form, that will spit out a quote based on a 3 tiers of variables.

1. Distance

The admin will be able to set a base zip code (98199 for example). They will be able to set a base fee for different distances to travel. So if someone imputs a zip code 15 miles away, they can have it quote a different fee than 45 miles away.

2. Type of Service

These will be checkboxes of which one must be checked: Single Mortgage, 80/20, Personal/Single Doc (Will, Affidavit, Grant Deed, ect)

The backend user will be able to add a certain dollar amount to the fee if one of the first two boxes is checked, and minus from the base fee (which is the distance fee) if the personal/single doc is checked.

3. Additional Services

Two more variables. checkboxes again, of which one must be checked.

1. Edocs. 2. Overnite.

If edocs is checked backend user can specify a dollar amount to add to base fee.

If overnite is checked, take no action because the base fee (based on distance) will be used to calculate.

Other Imputs

Please have an additional imput for a e-mail address (which will be required to spit out the quote)

Please have an additional imput for a phone number (optional).

that's it. This is for my mobile notary business where we travel alot and our fee quotes are based primarily on distance, type of loan to be signed, and if we have to print the documents or they will be overnited to us. Thanks!

Færdigheder: Dataindførsel, Databehandling, Javascript, Perl, Web Design

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Om arbejdsgiveren:
( 42 bedømmelser ) Seattle, United States

Projekt-ID: #88987

Tildelt til:

soner

I can do your project. Please contact for complete quote. thanks

$100 USD in 3 dage
(37 bedømmelser)
7.3

2 freelancere byder i gennemsnit $75 for dette job

saikiran79

I am very much interested in this job. Request you to please check ur PM now. Thanks Sai Kiran

$50 USD in 3 dage
(0 bedømmelser)
3.0