Web Inport Form + Print Page

What I would need is a form in any format. See the attached file for form info and fields. This will be web based input form KEY FIELD is the HWB# this field has to be filled in with a current next number in squence starting with a D##### (pound signs are number places)

After the form is filled out I'll need a submit button that will send the form to an email address and if it is easy to a database on a website that I can read later.


Mark Rogers

Second when the end user hits the "submit" button I will need a pop-up window that comes up so they can print out a few of the fields they have inputed

Fields Needed on popup page



* these need to be right accross from each other half page of paper with each

Then on the bottom half of the page

Pieces - Description - Weight Class -NMFC# - HAZ


Habilidades: Adobe Flash, Processamento de dados, Java, Javascript, PHP

Veja mais: web mark, web format, mark fields, format web, Web java, user form, print website, print @, haz, consignee, php pop form, form submit php, page database, web based form, send form email address, description page, next page, send page email, send page, email page print page, end user input, filled form, web database send email, page java, java input field

Acerca do Empregador:
( 1 comentário ) Surprise, United States

ID do Projeto: #157416

Concedido a:


Please check your pM!

$200 USD em 3 dias
(70 Comentários)

4 freelancers estão ofertando em média $125 para esse trabalho


I can do this. Please Check PMB..

$100 USD em 1 dia
(12 Comentários)

Please check your PM

$100 USD em 1 dia
(3 Comentários)

Hello. I have a great experience with this kind of work, so I can fulfill this assignment very well. Thanks.

$100 USD in 7 dias
(0 Comentários)