Simple PHP/MySQL form

URGENT! 48H-72H...

We need a freelancer to make a web form (in PHP with MySQL) out of a paper form.

The paper version of the form is the attachment (the two last pages of the document). The final web form should have a similar disposition to the actuel form. We'll provide you the requiered fields. A validation should also be done on selected fields (phone number, webmail, etc.). There will also have some minor modifications to do (eg. add a "I understand that blab blah blah" cheekbox and a 200 words textfield).

We also are looking for an administration panel (with a password) where admins will be able to delete or modify entries. We will be able to show you exactly what we are looking for.

If you bid on this project, please have some realisations to show. You'll also need to be able to complete the job before or on saturday... You can use any PHP tools you want.

We are looking for someone who will be able to do a minimalist but good-looking CSS job. We will pay a bonus for a fast & clean job.

Thank you!

Evner: CSS, HTML, Javascript, MySQL, PHP

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Om arbejdsgiveren:
( 9 bedømmelser ) Joliette, Canada

Projekt ID: #4115369

Tildelt til:


hey :) please see PM

$150 CAD in 3 dage
(84 bedømmelser)

10 freelancers are bidding on average $133 for this job


Quality work assured. Ready to get started. Thanks.

$400 CAD in 2 dage
(414 bedømmelser)

I have sent a private message to your inbox that contains my relevent skills and any questions I have.

$120 CAD in 0 dage
(181 bedømmelser)

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

$120 CAD in 4 dage
(98 bedømmelser)

We understand that we are new to freelancer but not in this industry. You can see our previous works in the inbox message and decide for yourself. You would have the best professional work possible. Look forward to dis Flere

$120 CAD in 2 dage
(17 bedømmelser)

Hi, We can build you the web form exactly as per your requirement . Have sent you more details about the project via PMB .

$120 CAD in 2 dage
(10 bedømmelser)

Hi, I'm interested that projects - please check PM for more details.

$250 CAD in 2 dage
(10 bedømmelser)

ready to start job now. thanks

$50 CAD in 0 dage
(7 bedømmelser)

Have a kind at PM.

$100 CAD in 2 dage
(8 bedømmelser)

I have built many forms using Ajax, creating a clean form submission. I can have this done for you fast.

$100 CAD in 2 dage
(0 bedømmelser)

Hello I have a elegant and efficient design as per your requirements

$50 CAD in 2 dage
(0 bedømmelser)