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PHP Contact Form - Reposted

This has been reposted as the winning bidder is now refusing to do the work. Please only bid if you are serious!

We are looking to enhance the current contact form that can be viewed at: [url removed, login to view]

The form is HTML and the script should be PHP.

We want the contact form to have the following fields:

These ones are mandatory fields and there needs to be validation to ensure that they have been populated

Your full name

E-mail address

Your telephone

Company name

These fields are check boxes and are option fields but at least one of them must be selected. The default value is for them to be blank:

PerTOOLS Financial Analysis for Excel

PerTOOLS Data Extractor for Excel

The following field will be a list (we already have the values that need to be in the list and can provide them):

Country

When the user selects the submit button there should be validation to ensure the form has been correctly completed. If the form has not been correctly completed show the user an error message explain what they need to change. If it has been correctly completed the following page should be displayed [url removed, login to view] The data that has been collected needs to be emailed to two different addresses.

The first email is to our email address and every time the form is submitted this address should receive a copy of the details.

The second email address will depend on which country the user has selected (e.g. if a user selects USA the details go to one email address, if they select the UK the email goes to another address). We need to be able to send request for each country to a different email address.

An email should be sent to the Client with the following details:

From:

Subject: Free Trial Request

Content:

Thank you for your Free Trial Request. Your request has been passed to your local distributor who will contact you shortly.

If you have not received your free trial within 24 hours, please contact

Many Thanks

The PerTOOLS Team

For the look and feel of the form, please look at the current one at: [url removed, login to view]

Feel free to ask any questions. We are looking to get this done as soon as possible.

Færdigheder: PHP

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Om arbejdsgiveren:
( 1 bedømmelse ) Letchworth Garden City, United Kingdom

Projekt-ID: #277686

Tildelt til:

firstdandy

Dear Sir, I can do this easily. I think can do this not more than 24 hours for first version. Please take a look at pmb for previous works. Thanks

$50 USD på 1 dag
(129 bedømmelser)
7.3

19 freelancers are bidding on average $50 for this job

lightcresent

Get the delivery within next 3 hours max.... Thanks

$50 USD in 0 dage
(482 bedømmelser)
9.0
brycep

Hi,Let's get it done [url removed, login to view],Bryce

$65 USD på 1 dag
(202 bedømmelser)
7.8
becomeexpert

Very simple, let me do it. Thanks, Tonmay

$50 USD på 1 dag
(130 bedømmelser)
7.6
WSTIBS

We can provide you complete solution with high quality work and time base completion. Thanks Worldsofttech

$40 USD in 0 dage
(105 bedømmelser)
7.4
outsourcedev

Please check it out the PM for more info, thanks…

$30 USD in 0 dage
(96 bedømmelser)
6.8
javeline

Please check your PMB

$50 USD in 2 dage
(9 bedømmelser)
6.6
mitrasubir

Hi, Lets start. Thanks KD

$45 USD på 1 dag
(38 bedømmelser)
6.6
vindhyavart

Please check PMB. Thanks.

$45 USD på 1 dag
(45 bedømmelser)
5.9
ITRACK

Pls see PMB

$50 USD på 1 dag
(111 bedømmelser)
5.9
maridari

Hello, please check PM thanks, Marianna

$55 USD in 0 dage
(20 bedømmelser)
5.8
SteeleR

can do it right away.. See PMB

$50 USD in 0 dage
(14 bedømmelser)
5.4
patrickfromchina

hi, experienced php coder. thank you,

$60 USD in 3 dage
(4 bedømmelser)
4.3
onlinehub

please see your pmb

$50 USD på 1 dag
(8 bedømmelser)
3.5
verso2000

Thank you.

$50 USD in 2 dage
(0 bedømmelser)
0.0
chitanava

see my bid

$45 USD på 1 dag
(0 bedømmelser)
0.0
kunnal

Hello Sir, The task is very easy and quite intersting.I can do this and make u sure that it will get completed as per given [url removed, login to view] will appreciate our work. Thanks Starsd

$44 USD in 5 dage
(0 bedømmelser)
0.0
MST4U

I have a demo ready for you ! Lets finish it in an hour . Check PM plz.

$50 USD in 0 dage
(0 bedømmelser)
0.0
rahul10721

it will be done!!!

$65 USD in 5 dage
(0 bedømmelser)
0.0