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Form Validation Update

Hello everybody!!!

I have this contact form someone made for me here in GAF, now I need to update it.

Here are the files take a look at them. It’s a html (main form) a php (the one that sends the form information) a js file (validation) and a css file.

Take a look at it and press the submit claim so you can look at what it does.

I need to update that contact form with this information:

MAKE SURE THAT EVERYONE FILLING OUT THE “SUBMIT CLAIM" FORM MUST CLICK ON THE HIGHLIGHTED "COMMISSIONS" AND” TERMS AND CONDITION" WORDS TO PROCEED. I WANT TO MAKE SURE THEY READ AND UNDERSTAND THE FEES WE CHARGE AND THE TERMS AND CONDITIONS. THEY MUST CLICK ON BOTH HIGHLIGHTED AREAS TO PROCEED. IF THEY DON'T OR FORGET, PLEASE HAVE A WINDOW TO POP UP STATING THEY MUST VIEW THE "COMMISSIONS" AND "TERMS AND CONDITIONS"

ADD THE FOLLOWING ADDITIONAL QUESTIONS TO CLAIM FORM.

WHERE IT SAYS ON THE TOP OF THE "SUBMIT CLAIM FORM" "PLEASE ENTER YOUR INFORMATION HERE"

I WANT YOU TO PUT THIS ON THE DIRECT BOTTOM LIKE THIS: "TYPE NS (NOT SURE) ON INFORMATION YOU DON'T KNOW"

WHERE IT SAYS “PLEASE ENTER DEBTOR INFORMATION HERE" PLEASE PUT ON THE DIRECT BOTTOM OF THAT ““TYPE NS (NOT SURE) ON INFORMATION YOU DON'T KNOW"

WHERE IT SAYS "PLEASE ENTER YOUR INFORMATION HERE" PLEASE PUT AT THE TOP "DATE:"

WHERE IT SAYS “PLEASE ENTER YOUR INFORMATION HERE" ABOVE "YOUR FULL NAME" PLEASE PUT” Date:

"WHERE IT SAYS "PLEASE ENTER YOUR INFORMATION HERE" AFTER " DEBTOR FULL NAME" PUT" DEBTOR SOCIAL SECURITY NUMBER" AFTER " DEBTOR SOCIAL SECURITY NUMBER" PUT " DEBTOR DATE OF BIRTH"

AFTER WHERE IT SAYS "DEBTOR EMAIL" PLEASE PUT " ARE YOUR INVOICES OR NOTICES YOU SEND IN THE MAIL TO THE DEBTOR BEING RETURNED TO YOU? ( ) YES ( ) NO"

AFTER “ARE YOUR INVOICES OR NOTICES YOU SEND IN THE MAIL TO THE DEBTOR BEING RETURNED TO YOU? ( ) YES ( ) NO" PLEASE PUT “DO YOU HAVE A SIGNED CONTRACT, SIGNED NOTE, OR PROOF OF DEBT BEING OWED?"

AFTER "DEBTOR ADDRESS" PLEASE PUT “EMPLOYER NAME"

AFTER “EMPLOYER NAME" PLEASE PUT “EMPLOYER ADDRESS"

AFTER “EMPLOYER ADDRESS" PLEASE PUT “EMPLOYER CITY, ST, ZIP"

AFTER “EMPLOYER CITY, ST, ZIP" PLEASE PUT " EMPLOYER TELEPHONE NUMBER"

That is all!!!

I need the new fields and radio buttons to validate as the existing ones.

Thank you!!!

Habilidades: Javascript, PHP

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Acerca do Empregador:
( 51 comentários ) San Ysidro, Mexico

ID do Projeto: #144239