Em Andamento

PHP/ AJAX Email Form with images

We need you to script out the email form mocked up on this page: [url removed, login to view]

Only script out the one form shown (within the open tab).

The form must submit to more than one recipient, and it must trigger a "success" message as well as a text email to the person who filled out the form.

Sample Email Content (sent to multiple recipients)

Subject: Vaporizer / Exchange Order From

Content:

Vaporizer / Exchange Order From

Vaporizer: Draeger 2000

Type of Agent: Isoflurane

Type of Filler: Key Fill

Type of Back or Mount: Fixed

Name: Sample Name

Email:

Telephone: 111-111-1111

Additional Comments:

Success Email sent to sender

Email Content of success email

Subject: Vaporizer / Exchange Order From

Content:

Dear <Name>

Thank you for contacting General Anesthetics Services, Inc. We will be contacting you within 48 hours to get your payment information and complete your order. Below is the information you sent us:

Vaporizer / Exchange Order From

Vaporizer: Draeger 2000

Type of Agent: Isoflurane

Type of Filler: Key Fill

Type of Back or Mount: Fixed

Name: Sample Name

Email:

Telephone: 111-111-1111

Additional Comments:

Many thanks!

name of company

Habilidades: AJAX, PHP, Arquitetura de software

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Acerca do Empregador:
( 131 comentários ) Pittsburgh, United States

ID do Projeto: #5120415

Premiar a:

csajit

Hello there, PLEASE CHECK MY REVIEWS AND THEN DECIDE ON ME. I AM AVAILABLE NOW....LET ME KNOW IF YOU HAVE ANY QUESTIONS. THANKS, AJIT

$54 USD em 2 dias
(143 Avaliações)
5.8

15 freelancers estão ofertando em média $116 para este trabalho

gopalvora

Hi ready to start i had more than 5 year experience in the php ,mysql with ajax etc.. so let me know your view Thanks

$144 USD in 8 dias
(228 Comentários)
7.2
DeamonBizz

We can do it. ""Please have a look on below links: www.kwikfundme.com http://zooeymagazine.com http://lifeinsurancequotes-online.org www.facelook.com www.miketyson.com http://bergenwa Mais

$178 USD in 7 dias
(88 Comentários)
6.8
froiden07

Hello, I can do this. looking forward to work on this project. Regards Froiden ............ ...............

$54 USD em 1 dia
(115 Comentários)
6.1
janudvs

Can I help you? I have more then 4 years exp. Also I already complete this type of work for one of my client. Please check here http://localhost/test/Contact_FishyDate.html its send mail using ajax and then r Mais

$88 USD in 3 dias
(25 Comentários)
5.6
devbogdan111

Hello, ready to start. I can complete your form in no time using jQuery, please consider my bid. Best Regards!

$155 USD in 2 dias
(11 Comentários)
5.0
srajbr

Hi, I am ready to do it ASAP. Please let me know if your server configuration. Does it support php, sendmail? If you are unaware of it let me know which hosting provider you use and your plan. Regards, Samiran

$50 USD em 1 dia
(16 Comentários)
4.1
praveen458

Hi, I am a javascript and php programmer. I am available now to work on your job,I have done a similar job for my last websites forms which validates and email the submitted data and notifies the user.The layout used c Mais

$35 USD in 3 dias
(16 Comentários)
4.1
miraclesolution

Greetings We would like to discuss in more details before placing a confirm bid. Let us know if you have some time to chat on Freelancer. Awaiting to hear from you,Have done similar work to your requirements in the Mais

$178 USD in 6 dias
(13 Comentários)
4.0
webspicevw

Hi . I can do this email form. I have done such works before and i am pretty confident in doing it again.

$45 USD in 3 dias
(41 Comentários)
3.3
adminCMS

hello, my name is stanimir, from bulgaria, i want to help you. this is intereting project! Thanks. Stanimir

$177 USD in 9 dias
(3 Comentários)
2.1
AliSafder

I have over 5 years of experience in Databases like Sql Server, Oracle, Microsoft Access and MySQL, Programming languages like .Net technologies(Asp.Net, Vb.Net / C#.net ) ,PHP, WordPress, SharePoint, VBA, C, C++ Mais

$144 USD in 3 dias
(1 Comentário)
1.4
ggabor67

Hi connellyp, I have 25 years experience in programming, 15 years in web-developing. I can fulfill your requirements, depending on your current environment I can suggest best solution after a short discussion. R Mais

$200 USD in 7 dias
(1 Comentário)
1.1
taru123

Hi, This is very easy. I have done this kind of functionality in many websites like http://www.mclarencoaching.com/contact-us/ http://pharrforda.com/volunteer/ http://weinberger4judge.com/get-involved/ Thank Mais

$111 USD in 5 dias
(0 Comentários)
0.0
shamim194

dear sir, i can do that very fast. if you contact me i can do that within 4 hour. after complete the task you can pay.

$130 USD em 1 dia
(0 Comentários)
0.0