Need rework of PHP webpage

Hi. Please take a look at [login to view URL] and click on the loan app link on the right hand side near the top. Something happened to this page today - it used to work fine but when I uploaded something it stopped working. When people fill out the page and hit the preview button a new screen is supposed to pop up (I'm sure this page is on the website somewhere) and give the opportunity to modify or submit. The fields need to be checked to make sure they are entered correctly. Then when the form it submitted it gets emailed... and the user gets a copy of the form via their email. This needs to be fixed immediately. ## Deliverables 1) Complete and fully-functional working program(s) in executable form as well as complete source code of all work done. 2) Deliverables must be in ready-to-run condition, as follows (depending on the nature of the deliverables): a) For web sites or other server-side deliverables intended to only ever exist in one place in the Buyer's environment--Deliverables must be installed by the Seller in ready-to-run condition in the Buyer's environment. b) For all others including desktop software or software the buyer intends to distribute: A software installation package that will install the software in ready-to-run condition on the platform(s) specified in this bid request. 3) All deliverables will be considered "work made for hire" under U.S. Copyright law. Buyer will receive exclusive and complete copyrights to all work purchased. (No GPL, GNU, 3rd party components, etc. unless all copyright ramifications are explained AND AGREED TO by the buyer on the site per the coder's Seller Legal Agreement). ## Platform web and php