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HTML contact form coding

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: #4108691

7 freelancere byder i gennemsnit $69 for dette job

toinnisfree

quick pro help. ftp and escrow required.

$85 USD på 1 dag
(539 bedømmelser)
7.9
k1ng440

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

$100 USD in 2 dage
(97 bedømmelser)
6.5
gopasoft

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

$70 USD in 2 dage
(27 bedømmelser)
4.6
vw1880582vw

I am an experienced software developer and have 17 years experience working with the technologies you require.

$30 USD på 1 dag
(6 bedømmelser)
4.1
kolnstyle

I've built quite a few contact forms before and I can get this done in a day.

$80 USD på 1 dag
(9 bedømmelser)
3.4
simonoop

Hi! I'm more than qualified to code a contact form like the one you described. I'm sending you a PM with some more info, etc. Cheers.

$80 USD på 1 dag
(3 bedømmelser)
3.0
lechatre662003

Very easy! I am available to start immediately.

$35 USD på 1 dag
(3 bedømmelser)
1.6