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One Page Form for Club Membership

I need someone to make a 1 page web from using the file provided for the look and feel. The fields are as followed:

name:

Address:

City:

State:

Zip:

email address:

Mac or PC:

How did you first hear of Enterprise Computer:

Friend, Yellow Pages, Newspaper, Coupon Book, Radio, TV, OTHER:

It must have a send button that emails it to me

and saves it to an Excel, tab delimted file on my website.

It will be located at [url removed, login to view]

Færdigheder: Web Design

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Om arbejdsgiveren:
( 8 bedømmelser ) Clinton, United States

Projekt-ID: #56152