I'm in need of a small order page similiar to this one
[url removed, login to view]
I will need roughly 8 selection boxes for various options. This form must be able to prorate the total based on the number of days remaining in the month. They user will then submit and see their quote. If they like it they can click on a new button that appears that says "purchase now". This page will ask for personal information via our secure site. This will include:
Name,Address,City,State,Zip,Phone #, and email address.
This will then go to a post page where we can finish it up by storing the data into our mysql database.
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).
This will need to be html/php for RH Linux 9.0.