Create online registration for an existing website

I am to move my product registration process from a physical registration card to online registration on an existing website. The website is already completed and I only require the addition of a page for registration.

The registration page should contain the following queries:

* First name

* M.I.

* Last name

* Mailing Address

* Home or Business

* City

* State

* Zip

* Home Phone

* Business Phone

* Fax

* Email Address

* Date of Purchase

* Model Number (located on "Made in USA" sticker)

* Name of Store

Attached is a copy of the physical registration card that we are currently using.

Færdigheder: PHP, Software Arkitektur

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Om arbejdsgiveren:
( 17 bedømmelser ) Lafayette, United States

Projekt-ID: #6034208

4 freelancers are bidding on average $126 for this job


Hello, sir I'm interested with your project. I have good skill and my place is 8th in freelancer. I'll do it for you. I can do it well more than you could guess. :) If you give me t Mere

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