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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...

Færdigheder: 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
(91 bedømmelser)
6.7

44 freelancere byder i gennemsnit $42 for dette job

naumanrandhawa

Perfect man for this job.

$50 USD på 1 dag
(147 bedømmelser)
7.1
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
(139 bedømmelser)
6.8
royind

Ready to start. Thanks.

$30 USD på 1 dag
(43 bedømmelser)
6.7
ssahilsl

We have really experienced in web design and development, Graphic Design and Landing page Design, Logo, Banner, Brochure, HTML, XHTML, HTML5.Please open message board for previous results and let's award us. Regards Di Mere

$30 USD på 1 dag
(96 bedømmelser)
6.7
stevebryant

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

$30 USD på 1 dag
(432 bedømmelser)
6.5
nbcrony

Let start.

$30 USD på 1 dag
(31 bedømmelser)
6.1
sinisa

Hello, can be done very fast.

$40 USD på 1 dag
(101 bedømmelser)
6.1
udanaudayanga

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

$30 USD in 0 dage
(47 bedømmelser)
5.7
samzinc

Kindly check your pmb

$120 USD på 1 dag
(47 bedømmelser)
5.7
andrespa

Clear with requirements and ready to start. Thank you.

$60 USD på 1 dag
(31 bedømmelser)
5.6
csajit

LETS DO IT!!!

$30 USD in 0 dage
(122 bedømmelser)
5.5
jcodemasters

Hello, can do it in a day.

$75 USD på 1 dag
(46 bedømmelser)
5.5
tomstat123

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

$50 USD på 1 dag
(30 bedømmelser)
5.5
burtzerk

I can have this done in an hour if you grant the project to me.

$50 USD på 1 dag
(25 bedømmelser)
5.4
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
(34 bedømmelser)
5.3
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 Mere

$30 USD in 0 dage
(35 bedømmelser)
5.2
Tharawen

Hi, please see PM for details

$30 USD in 0 dage
(39 bedømmelser)
5.0
milenhristov

Hello, I'm software developer with over 11 years experience with PHP, MySQL, JavaScript, HTML, CSS. Please see my profile/resume for more details. I can finish the task in next few hours. Best Regards, Milen

$35 USD på 1 dag
(18 bedømmelser)
5.0
gopasoft

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

$34 USD på 1 dag
(27 bedømmelser)
4.6
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
(36 bedømmelser)
4.6