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Create 2 additonal pages for an excisting website for receiving quotes

A customer of me needs a page where visitors from Google Adwords can enter detailed information for requesting quote of a specific object.

The customer needs one page wich contain the following details:

* * *

**Type

O** Name 1

**O** Name 2

**O** Name 3

**Contact details

**Firstname

Name

Gender

Phonenumber

Mobile

E-mail

**Adress

**Adress

Postal code

City

Country

**Detail info 1

O** variable distance

**O** Unknown

**Detail info 2

O** variable degrees

**O** Unknown

**General info

**Desired date of execution days selection - month selection - year selection

Contribution field

Send request button

* * *

When the customer clicks the Send request button the customer needs arrive on the 2nd page you have to make wich will thank the customer for his request. (And where i could put the Adwords code)

For an example you can view this page:

<[url removed, login to view]>

Enter as "Uw postcode" the following: 1234 ab

Then you see the page i would like to have for my customer.

It would be great if it fits in this entire picture as in layout of the current website, wich is:

<[url removed, login to view]>

Habilidades: Engenharia, MySQL, PHP, Gestão de projetos, Arquitetura de software, Teste de Software, Interface do usuário / AI

Ver mais: receiving quotes, my e mail adress is, mobile contact management, code for website layout, 2 year degrees, adwords mobile, mobile nl, gender selection, create 2, create mobile page, google receiving, http receiving, quote button website, google adress, 2nd layout, google postcode, customer quotes, 2nd page google page, google adwords customer, google adwords php code, gender country, management quotes, visitors management, create enter, picture object

Acerca do Empregador:
( 38 comentários ) Netherlands

ID do Projeto: #3048991

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Purplecoder

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$21.24 USD em 6 dias
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5.1

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phpMaestro

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