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Small PHP page created

I need a small page written in php.

I have attached files that I have started with and would like to build off of.

( i'm not picky if the design needs to be changed, just sample files I had.)

The user fills out the fields and submits the form on the same page. I do not want the user to have to leave the page. Once the form has been submitted I'd like a "Thank you" message to display at the top and then fade or go away after 5 seconds or so for confirmation the form was successful.

In the backend, when the form is submitted, I need the information sent to a URL. The php file contains the code that I created that successfully curl/send the URL to where it needs to go. If you need to change it or make it better then please go for it.

Here is the info for that and the variables that need to be set:

- "Login" needs to be set to requester_login and requester_name in the URL

- "Station #" and "Device" need to be combined to the short_description in the URL

- "Problem" text area needs to be set to details in the URL

Please put YES as the first word in your post so I know you've read it. Thank you.

Færdigheder: AJAX, Javascript, jQuery / Prototype, PHP, Software Arkitektur

Se mere: small admin page php, php small logo page, make printable page php, make multi page php, make intro page php, small mysql page php, user registration page php, php small, redirecting previous page php, search results page php

Om arbejdsgiveren:
( 7 bedømmelser ) Cibolo, United States

Projekt-ID: #12531042

Tildelt til:

sharmarahulraman

Hi, I have 6 year experience and I am ready to start your project right now. my skill are: Web Developer & Designer (Wordpress, Core php, Magento, joomla, Prestashop, drupal, Responsive, Bootstrap) I am sure t Mere

$35 USD på 1 dag
(22 bedømmelser)
4.2

6 freelancere byder i gennemsnit $38 for dette job

aswani11

YES Hi My name is Aswani and I am an expert in web development. I would love to have the opportunity to discuss your project with you. I believe my skills are a match for your project. I have a good grasp of w Mere

$40 USD på 1 dag
(10 bedømmelser)
3.8
citsoftwares

YES Hello Sir/Madam, First,have a look at some of my previous work samples: http://joshpyatt.com.au/ http://www.spiceprofessors.com/ https://www.entosource.com/ http://www.agrawaljewels.com/ http://midasthai Mere

$75 USD på 1 dag
(12 bedømmelser)
3.5
Charlesri

YES Hello I am a expert Ajax/php. I will provide successfully result. regard .

$25 USD in 0 dage
(13 bedømmelser)
3.7
lucianovvitetti

YES Hello, So you need just to send the data from the form to that url and display a message if users completes all fields? All fields are required? Also it should be a message to complete a Mere

$20 USD på 1 dag
(3 bedømmelser)
2.6
alliedbandna

Dear Sir, Your have recently advertised for website developer . After reading the job description I am confident that I would be a perfect fit for this position as my experience and abilities precisely match your requ Mere

$111 USD in 5 dage
(9 bedømmelser)
2.6
CodeGuru009

Yes I have read details and ready to start the job, regards

$30 USD på 1 dag
(1 bedømmelse)
2.0
rizwanmiraj92

Hi, i'm expert php developer and web developer . i can do your task in best way and in time. you will be satisfied with my service.

$30 USD på 1 dag
(1 bedømmelse)
0.0