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Need secure web based form

I need a secure web based form, to be used in a WordPress site, that collects all the same data and has a similar look to the form found at this URL:

[url removed, login to view]

I will need to collect a few additional pieces of information other than what is requested on that site.

Habilidades: Engenharia, MySQL, PHP, Gestão de projetos, Arquitetura de software, Teste de Software, Hospedagem Web, Gestão de Site , Teste de Website

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Acerca do Empregador:
( 0 comentários ) Thailand

ID do Projeto: #3020702

2 freelancers estão ofertando em média $26 para este trabalho

ssharma1622

See private message.

$25.5 USD in 14 dias
(89 Comentários)
5.5
credentsolu

See private message.

$25.5 USD in 14 dias
(4 Comentários)
3.3