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HTML contact form coding - repost

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...

Evner: Grafisk Design, HTML, MySQL, PHP

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Om arbejdsgiveren:
( 4 bedømmelser ) Commack, United States

Projekt ID: #4108753

Tildelt til:

NeOLiO

Hi, I can deliver form to database code with ip address capturing. Please check PMB. for complete details. Thanks.

$30 USD på 1 dag
(157 bedømmelser)
7.1

43 freelancere byder i gennemsnit $42 på dette job

naumanrandhawa

Perfect man for this job.

$50 USD på 1 dag
(200 bedømmelser)
7.6
samzinc

Kindly check your pmb

$120 USD på 1 dag
(201 bedømmelser)
7.4
royind

Ready to start. Thanks.

$30 USD på 1 dag
(65 bedømmelser)
7.2
ssahilsl

We have really experienced in web design and development, Graphic Design and Landing page Design, Logo, Banner, Brochure, HTML, XHTML, [login to view URL] open message board for previous results and let's award us. Regards Di Flere

$30 USD på 1 dag
(202 bedømmelser)
7.4
majma01

expert web developer can do this job in just one hour, check pmb

$50 USD in 0 dage
(232 bedømmelser)
7.2
jcodemasters

Hello, can do it in a day.

$75 USD på 1 dag
(58 bedømmelser)
6.5
stevebryant

Hi, I can work that form. Ready to start. Regards, Steve

$30 USD på 1 dag
(451 bedømmelser)
6.6
csajit

LETS DO IT!!!

$30 USD in 0 dage
(277 bedømmelser)
6.8
freeworks

Hi, I saw your project description. I will do that on time. I will do custom design and coding for you. Please check my profile and portfolio. Thanks

$30 USD in 0 dage
(152 bedømmelser)
6.9
sinisa

Hello, can be done very fast.

$40 USD på 1 dag
(141 bedømmelser)
6.7
udanaudayanga

Hi, Can code the subscription form as you can use it any where. Just few hours work.

$30 USD in 0 dage
(72 bedømmelser)
6.2
nbcrony

Let start.

$30 USD på 1 dag
(34 bedømmelser)
6.2
andrespa

Clear with requirements and ready to start. Thank you.

$60 USD på 1 dag
(44 bedømmelser)
6.3
Softanz

Professional developer here. I am 6+ years experience in HTML, PHP5, CSS ,MySQL, Ajax, Jquery, JavaScript, Wordpress. My portfolio and review will clarify my skills.I can quickly help you to get it done on-time and wit Flere

$30 USD in 0 dage
(65 bedømmelser)
6.0
gopasoft

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

$34 USD på 1 dag
(53 bedømmelser)
5.5
tooltor

Ready to start here, I will build the forms according to the design of your website and will save the information into your database and with a copy into your email. Please check the private message.

$50 USD in 0 dage
(49 bedømmelser)
5.5
callumbwhyte

I have just finished two very similar projects on here and I'll do this within a few hours!

$30 USD på 1 dag
(64 bedømmelser)
5.7
Tharawen

Hi, please see PM for details

$30 USD in 0 dage
(52 bedømmelser)
5.3
tomstat123

experienced developer. I have done similar form. I can do this.

$50 USD på 1 dag
(48 bedømmelser)
5.8
binarygeotech

Easy task, I can start NOW! contact me.

$80 USD in 2 dage
(34 bedømmelser)
5.4