modify the contact form template

I just need to modify the contact form template: [url removed, login to view]

The fields should be:

Nombre (text)

Mail (mail valid)

Dirección (text)

Fono (text)

Pedido (selection menu) OPTIONS: -Cilindro 5kg -Cilindro 11kg -Cilindro15kg -Cilindro 45kg

Información Adicional (text) (big field)

Ideally keep the template format.

Evner: CSS, HTML, PHP, Web Design

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Om arbejdsgiveren:
( 4 bedømmelser ) Santiago, Chile

Projekt ID: #6029431

Tildelt til:


This job would only take a minute for our group of skilled developers. You would be able to track our project using our project management system on our website that makes the project quicker and to your standards. We Flere

$5000 CLP in 0 dage
(0 bedømmelser)

14 freelancere byder i gennemsnit $22350 på dette job


Could we have a quick word to discuss the project ? Please visit my relevant wordpress example [url removed, login to view]://[url removed, login to view] [url removed, login to view]://[url removed, login to view] [url removed, login to view]://[url removed, login to view] [url removed, login to view]://[url removed, login to view] [url removed, login to view]://shahla Flere

$157894 CLP in 6 dage
(68 bedømmelser)

Hello, Saw your job posting and your requirement seems perfect for me as per My skills. Here you can see my work portfolio with some samples of my work.. [url removed, login to view] We are a team of 14 ful Flere

$14000 CLP in 20 dage
(9 bedømmelser)

Dear Sir, We claim to get it done perfectly for you EXACTLY in the way you want it - Kindly give we a chance and we will prove myself - Ready to prove our words, let's get it done right away and I mean RIGHT AWAY !! Flere

$22000 CLP in 2 dage
(72 bedømmelser)

A proposal has not yet been provided

$16500 CLP in 5 dage
(35 bedømmelser)

Hi, I can do your job but i need to talk before moving forward on this job. Let me know if this possible for you to talk few minutes. Regards Rina

$12000 CLP på 1 dag
(33 bedømmelser)

Dear sir > , VI World is Indian base company. You can see our work at [url removed, login to view] or in portfolio section. We provide best solution in low cost . So we want to discuss about your requirement. This price /time Flere

$11500 CLP på 1 dag
(21 bedømmelser)

Hello, I am a professional software developer with 4+ years experience with PHP with Zend PHP certification, CMS , Joomla, Wordpress, Opencart, Prestashop, Magento,Jquery, mysql, html, css ... Let me do it quick Flere

$7500 CLP på 1 dag
(43 bedømmelser)

Hola! como estas? yo puedo ayudarte a modificar el formulario de contacto, contacta conmigo para hablar de los detalles. Saludos!!!

$17000 CLP in 0 dage
(13 bedømmelser)

Dear Sir, I have more than 2 years experiences in web development like php,mysql and I hope I am able to help you. Please give me details what is needed to do? I hope if you give me the chance I will do that with Flere

$12500 CLP på 1 dag
(10 bedømmelser)

hello, we can do the needful. please send the details so that we can start as soon as possible. thanks

$15000 CLP in 2 dage
(3 bedømmelser)

A proposal has not yet been provided

$5000 CLP in 0 dage
(1 bedømmelse)

Hello,I am web developer (PHP). With knowledge of wordpress, cakephp,concrete5,zoho crm. I will provide you 100% result of project. my skype id is(rcronak)

$12500 CLP in 3 dage
(0 bedømmelser)

Hello, Very easy to do . Let me manage this for you. Check my portfolio please Thank you. Best Regards, Mohammed

$7500 CLP på 1 dag
(0 bedømmelser)

Hello Sir, I've read the project specifications furnished by you and have understood your requirements well. I am a passionate, qualified and experienced Web Development, having more than 2 year of experience Flere

$12500 CLP på 1 dag
(0 bedømmelser)

Hi I am an expert developer+designer from Japan. I can do this work for you. Hoping to get a positive response from your side. Regards

$12500 CLP på 1 dag
(0 bedømmelser)