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Simple Form

Hey there, I need a simple form for an upcoming website that will gather personal information from these fields: "First Name'", "Last Name", "Address", "Apt", "City", "State" (probably as a toggle/dropdown), "Zip", "Phone", "Email" and then a "Loan Amount" field and a "Certificate Number" field. This information then would be gathered with the gift the user would chose from the next page and have all information gathered in a database or emailed to an email address. None of the info needs to be secure/encrypted (I believe). This is a common form that many sites have. I am relatively familiar with HTML and a bit of java so code with instructions of where to place it would work.***It most likely would run on a Windows 2000 server, and I am not sure what else is needed hopefully no additional software (I do know that the current server can handle Cold Fusion). WHATEVER is the easiest way to gather information and a gift number and send all info to a database is what we are looking for. Site is not on the WWW yet, just in html. Thanks!

## Deliverables

1) Complete and fully-functional working program(s) in executable form as well as complete source code of all work done.

2) Installation package that will install the software (in ready-to-run condition) on the platform(s) specified in this bid request.

3) Exclusive and complete copyrights to all work purchased. (No GPL, 3rd party components, etc. unless all copyright ramifications are explained AND AGREED TO by the buyer on the site).

## Platform

IE and Netscape

Habilidades: Apple Safari, ASP, Cold Fusion, Processamento de Dados, Engenharia, Google Chrome, Java, MySQL, PHP, Arquitetura de software, Teste de Software, Interface do usuário / AI

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Acerca do Empregador:
( 0 comentários ) United States

ID do Projeto: #2988339

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