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I need a straightforward web form that lets users enter their name, choose how they intend to pay, add the anticipated payment date, and then hit “Submit.” On submission the form must send a confirmation email to both me and the customer through Gmail’s SMTP (or the official Gmail API if you prefer). Core requirements • Single-line text field for the customer’s name. • Drop-down list containing exactly these options, spelled and punctuated as written: – Theconnection renew – monthly – check to treasurer – credit card to treasurer • Free-text or date-picker field for “anticipated date of payment.” • A submit button that triggers two emails: one to my address and one to the customer’s, each carrying the details they just entered. The emails must route through Gmail so I can keep everything under the same provider. Acceptance criteria • Form loads cleanly on desktop and mobile. • Both emails arrive with the submitted data in a readable layout. • No third-party branding appears in the messages. • All entered information is cleared only after a successful send, with an on-screen success notice. If you’ve built similar HTML/CSS/JavaScript or PHP forms that hook into Gmail before, this should be a quick turnaround. Let me know your preferred stack and how soon you can deliver.
ID do Projeto: 40340104
143 propostas
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Ativo há 20 dias
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143 freelancers estão ofertando em média $155 USD for esse trabalho

I have extensive experience in PHP, JavaScript, Website Design, HTML, and Email Marketing, making me a great match for your project, "Custom Payment Form with Email." The proposed budget can be adjusted as we discuss the full scope. My priority is to work within your budget. I am confident in my ability to deliver quality results promptly. Please review my 15-year-old profile to see my past work. Your satisfaction is my top priority. Let's discuss the job details and get started. I am eager to show my commitment to this project. Looking forward to hearing from you.
$225 USD em 6 dias
8,8
8,8

Hi, You need a clean payment form that captures user details and payment method selection, then handles the email workflow. Quick question: are you processing payments through a gateway (Stripe, PayPal) or just collecting the info for manual processing? I've built dozens of these—fast, secure, no bloat. Message me to discuss the specifics. Best Regards, Hasan
$200 USD em 7 dias
8,8
8,8

Hi there, I’ve read your project carefully and I’m confident I can deliver a clean, reliable custom payment form that sends matching confirmation emails via Gmail SMTP or Gmail API, without any third-party branding. I’ve built similar HTML/CSS/JS and PHP-based forms with server-side mail delivery and a polished, responsive UI that works on both desktop and mobile. Here’s how I’ll approach it: • Frontend: a responsive form with a single-line name field, a precise dropdown with the exact options you listed, and a date-picker or free-text field for the anticipated date. The UI will stay minimal and accessible, with validation and a clear success notice. • Backend: a lightweight PHP (or Node.js) handler that composes two readable emails (customer + you) using the same Gmail sending method. I’ll ensure the mail body mirrors the submitted data exactly and is easy to audit. • Gmail integration: I’ll connect via Gmail SMTP (secure TLS) or the Gmail API, whichever you prefer, to ensure reliable delivery and centralized billing under your Gmail account. • UX flow: On submit, data is sent; on success, show an on-screen success message; then clear the form. If the send fails, an inline error with actionable steps will appear. I’ve shared an initial estimate based on your description, and once we go over a few technical details, I’ll confirm the exact cost and delivery schedule. I propose the following delivery plan: • 1) HTML/CSS/JS frontend prototype in 1 day • 2) Server-side email l
$75 USD em 3 dias
8,3
8,3

Hi, I can create a clean and user-friendly web form that meets your requirements and utilizes Gmail’s SMTP for email confirmations. The form will include the specified fields, ensuring everything is easy to use on both desktop and mobile. I’ll make sure the emails are well-formatted and contain the submitted data without any third-party branding. Additionally, the form will clear out information only after a successful send, along with a success notice for users. I’ve built similar forms using HTML, CSS, and PHP, so I can guarantee a quick turnaround. Looking forward to discussing your project further. Best Regards, Priyanka
$100 USD em 1 dia
8,5
8,5

Hi, I understand you need a clean, mobile-friendly web form that captures user name, payment method, and payment date, then sends confirmation emails via Gmail SMTP or API to you and your customers reliably. I will build a seamless HTML/CSS/JavaScript front end with a PHP backend to handle email routing through Gmail, ensuring no third-party branding appears. Your specified payment options and validation will be integrated as requested. I have developed similar forms with Gmail integration before, ensuring fast delivery and clear success notifications upon submission. I can complete this within 5 days and start immediately. Which Gmail integration do you prefer: SMTP or the official Gmail API for sending emails? Best regards, Muhammad
$200 USD em 5 dias
8,3
8,3

Hi, To create a web form that captures user details and sends confirmation emails, I understand you need a straightforward solution. I will build a form with a single-line text field for the name, a drop-down list for payment options, and a date-picker for the anticipated payment date. Upon submission, I will ensure that the form sends emails through Gmail's SMTP with the entered details. I will use PHP for the backend to handle the form submission and email sending, ensuring that both emails are formatted clearly and without third-party branding. The form will be responsive for both desktop and mobile views, and I will implement a success notice after the emails are sent. Could you please confirm if you have a specific Gmail account for the SMTP setup? Also, do you have any design preferences for the form? Let's chat or share any additional details needed to start the project. Thanks!
$80 USD em 1 dia
8,4
8,4

Hi, I have strong experience with Php, Laravel and Code ignitor. I’ll develop robust and secure web application just the way you want. I can handle any updates you need. You can check my reviews to see the quality of my work, I will share my previous application in private chat.
$80 USD em 2 dias
7,8
7,8

⭐⭐⭐⭐⭐ Create a Simple Web Form with Email Confirmation ❇️ Hi My Friend, I hope you're doing well. I've reviewed your project needs and see you're looking for a straightforward web form. You don't need to look any further; Zohaib is here to help you! My team has completed over 50 similar projects for web forms. I will build a user-friendly form that meets all your requirements and ensures smooth email confirmation through Gmail. ➡️ Why Me? I can easily create your web form as I have 5 years of experience in web development, specializing in HTML, CSS, and JavaScript. My expertise includes form creation, email integration, and responsive design. I also have a strong grip on PHP and Gmail API, ensuring your project is handled efficiently. ➡️ Let's have a quick chat to discuss your project in detail. I can provide samples of my previous work that demonstrate my skills. Looking forward to discussing this with you in chat. ➡️ Skills & Experience: ✅ HTML ✅ CSS ✅ JavaScript ✅ PHP ✅ Email Integration ✅ Responsive Design ✅ Form Validation ✅ Gmail API ✅ User Experience ✅ Database Management ✅ Debugging ✅ Problem Solving Waiting for your response! Best Regards, Zohaib
$150 USD em 2 dias
7,9
7,9

Hello, I’d be happy to build the clean, reliable payment form you described. I can create a responsive HTML/CSS/JavaScript front end with a PHP backend to handle Gmail SMTP securely, ensuring the form sends two clear, well‑formatted emails, one to you and one to the customer. I’ll include all required fields exactly as listed, add a smooth success notification, and clear data only after confirmation. The layout will be optimized for desktop and mobile, with no third‑party branding and a simple, professional look. I’ve built similar Gmail‑integrated forms, so turnaround will be quick. Best regards, Ahtesham
$150 USD em 2 dias
7,5
7,5

Woah Hello, You’re looking to create a simple web form where users can enter their name, select a payment method, and provide a payment date, all while ensuring that both you and the customer receive confirmation emails. I can definitely help with that! My approach would involve using PHP for the backend to handle form submissions and email sending through Gmail’s SMTP, ensuring both emails contain the submitted details in a clear format. With 7+ years of experience in web development, I’m comfortable building forms that work seamlessly on both desktop and mobile devices. I’ll make sure the form is user-friendly and that it meets your requirements, including clearing the input fields after a successful submission and displaying a success notice. Looking forward to working on this with you! Best regards, Ivan Mandinski
$35 USD em 3 dias
7,4
7,4

Hi, ➡️ I read your project description, and you need a custom payment form that integrates seamlessly with Gmail for sending confirmation emails. ⏺️ I specialize in building secure and efficient web forms using HTML, CSS, JavaScript, and PHP. My expertise includes creating forms that feature various fields such as single-line texts, drop-down lists, and date pickers, all while ensuring a clean design and functionality across all devices. I have extensive experience with Gmails API for email functionalities, ensuring that the form will meet all your specified requirements without any third-party branding. Regards, Aftab Ahmad Full Stack Developer (12 Years of experience)
$150 USD em 6 dias
7,4
7,4

Hello! I see you're looking for a custom payment form that seamlessly integrates with Gmail's API or SMTP. I've successfully built similar web forms that collect user data and send confirmation emails, ensuring a smooth user experience on both desktop and mobile devices. For your project, I'll create a user-friendly interface with the specified fields and functionality to trigger confirmation emails for both you and the customer. To enhance user experience, I suggest adding a tooltip on the date-picker field for clarity. In a past project, I developed a payment submission form for a local nonprofit that required similar email functionality. I delivered it in just three days with positive feedback. I can have your form ready within 5 days. Best regards,
$65 USD em 2 dias
6,9
6,9

Hi, I have carefully reviewed your project requirements for a custom payment form with integrated Gmail emailing, and I am writing this bid by myself with full confidence in delivering exactly what you need. Your straightforward form with precise payment options and Gmail SMTP integration aligns well with my prior experience developing user-friendly forms that send customized emails. I have built similar HTML, CSS, JavaScript, and PHP forms that send emails through Gmail’s SMTP or API without third-party branding. I will ensure your form is responsive across desktop and mobile, emails are clear and correctly formatted, and users see a success message once submission is complete. I am ready to start immediately and can have your form running within 5 days, ensuring smooth operation and solid email delivery. Which email sending method do you prefer: Gmail SMTP or the official Gmail API for better reliability? Best regards,
$100 USD em 5 dias
7,0
7,0

Hello I will build your custom, straightforward web payment form. It will securely integrate payments and automatically send email confirmations. Designed for ease-of-use, it ensures a smooth transaction experience for your users, streamlining your process efficiently. Giáp Văn Hưng
$250 USD em 7 dias
6,8
6,8

Hello, I’ll build a responsive BigCommerce-ready form with name, payment method, and anticipated payment date, plus your verification phrase. I’d use PHP and Gmail SMTP or the Gmail API to send clean, branded-neutral confirmation emails to you and the customer after validation. I’ll reset fields only after a successful send and show a clear success notice. Thanks- Webcast Technology
$160 USD em 1 dia
6,8
6,8

Hi, As per my understanding: Clean web form capturing name, precise payment dropdown (Theconnection renew, monthly, check to treasurer, credit card to treasurer), payment date; submits via Gmail SMTP/API sending formatted emails to both parties, with responsive design, success feedback, and form reset. Implementation approach: - Pure HTML/CSS/JS frontend, date input type for picker. - Lightweight PHP script for validation and Gmail SMTP emails. Queries: SMTP credentials handling? Email template tweaks needed? I'll share my portfolio on your first message. Best Regards
$550 USD em 12 dias
6,9
6,9

Hello, I can build a clean, responsive web form with the required fields and integrate Gmail SMTP for reliable email delivery to both you and the user. I’ll ensure proper validation, success messages, and a smooth user experience with no third-party branding. With over 7 years of experience in the development industry, I specialize in coding & custom development across a wide range of platforms & technologies. My expertise includes advanced WordPress theme and plugin customization, UX – focused front-end languages like HTML5, CSS3, JavaScript, jQuery, and AJAX, as well as Liquid code customization for Shopify. Thank you & Best Regards, Amit J.
$150 USD em 3 dias
6,7
6,7

Hello, there, I’ve carefully reviewed your project and am excited about the opportunity to work with you. With seven years of experience in web development and email integration, I specialize in creating clean, reliable HTML, CSS, JavaScript, and PHP forms that connect seamlessly to Gmail. I am confident I can deliver a custom payment form that collects user details and sends confirmation emails efficiently and effectively. Here’s my approach: Build a responsive form with the exact fields and dropdown options you specified. Implement a secure PHP or Gmail API email handler to send clean, branded emails to both you and the customer. I am available to start immediately and aim to deliver the full project within two days. Additional instructions / notes (optional): I can integrate either Gmail SMTP or the official Gmail API depending on your preference. I can also add optional validation for better data accuracy. Best regards, Jushua
$155 USD em 2 dias
5,9
5,9

Hi, I'll swiftly create a custom payment form as per your requirements. Utilizing PHP, JavaScript, and HTML, I'll ensure a seamless user experience on both desktop and mobile. By integrating Gmail SMTP for email delivery, I'll guarantee that you and your customers receive clean, branded-free emails with the submitted data. With my expertise in frontend and backend development, I'll deliver a user-friendly form that triggers automatic emails upon submission. Let's chat further to discuss how I can tailor the solution to your needs. Best regards, Noor
$140 USD em 2 dias
5,8
5,8

Hi, As a individual developer I’m available to start right away. I can help in your project focusing on web form development, Gmail SMTP or API integration, email automation, and related frontend and backend modules to fix, improve, and develop during this project. With my expertise in full-stack development and experience working with modern web technologies like HTML, CSS, JavaScript, PHP, Gmail SMTP, and API-based email workflows, I can build this quickly. I can create a clean responsive form with the exact fields required, implement reliable email delivery to both you and the customer, and ensure proper validation, success messaging, and data handling. You can expect clear communication, fast turnaround, and a high-quality result that fits seamlessly into your existing workflow. Best regards, Juan
$140 USD em 1 dia
5,8
5,8

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