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Create an online form to capture details on my homepage

$30-250 USD

Completed
Posted over 12 years ago

$30-250 USD

Paid on delivery
I need someone to create an online form which captures the details of people who visit my website. I have not launched my website yet, there is only a blog posted on it for SEO purposes, but I have some marketing going out in the newspapers, and I want to be able to capture the details of website visitors, and also direct them to the facebook fan page. I have the design of the website which I can provide. I want the same elements used. It needs to ask them if they are a Customer or Driver First Name Surname Mobile number Email Password Where did you hear about us (pulldown menu with a few responses) Agree to terms and conditions box. I want it up in 2 days. Only quote if you have good feedback.
Project ID: 1205717

About the project

12 proposals
Remote project
Active 13 yrs ago

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Hello, We can help you with the online form functionality for your website. Please check PMB. for details. Thanks.
$30 USD in 1 day
5.0 (117 reviews)
6.8
6.8
12 freelancers are bidding on average $66 USD for this job
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Hi, Will Provide you the online form with Exactly in 24hours :)Please review inbox!
$30 USD in 0 day
4.8 (147 reviews)
7.5
7.5
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Check Your PMB
$80 USD in 0 day
5.0 (69 reviews)
7.1
7.1
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Hello Sir, I am very much interested in your job. Please have a look at my PM. Thanks,
$100 USD in 2 days
5.0 (46 reviews)
6.5
6.5
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no problem for me, will make it up in just few hours from when i start working. i have many good feedbacks.
$50 USD in 1 day
4.9 (131 reviews)
6.4
6.4
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Hi,I can do this job for sure
$40 USD in 1 day
4.8 (66 reviews)
6.1
6.1
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Hi, I can make the form in 1 day with all the validations aswell. Just finished a form for www.dropmagic.com. This too is just to capture details , the website is not up designed yet. You can visit my portfolio at www.mywebdesignz.com. Regards, Gaurav
$50 USD in 1 day
4.9 (60 reviews)
5.8
5.8
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Hello, Please check your PMB. Thanks
$60 USD in 2 days
3.9 (37 reviews)
4.9
4.9
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Hi, TechinformaticsMedia is a growing Web Development Company in India. Kindly check PMB for more details.
$100 USD in 0 day
4.7 (12 reviews)
3.9
3.9
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Hi, I've been working as a web developer for more than 3years now ,and i've Proficiency in working with AJAX, PHP,MySQL,Javascript,HTML,CSS . I know i can deliver what you need. Please check PM for more info.
$45 USD in 1 day
4.9 (4 reviews)
3.7
3.7
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lets finish this.........please check PMB
$30 USD in 1 day
3.5 (14 reviews)
3.5
3.5
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Experience php developers which will create your project in given deadline..PLEASE CHECK YOUR PMB
$175 USD in 2 days
4.5 (3 reviews)
3.3
3.3

About the client

Flag of AUSTRALIA
Sydney, Australia
5.0
5
Payment method verified
Member since Mar 15, 2011

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