Em Andamento

add a form to this page

Real quickie, I need a form added to the bottom right of the main image on this page:

[url removed, login to view]

The data from he form is then to be entered into a database.

I need the form to have the following:

1. Your name

2. Company name

3. email address

4. Contact phone

and a send button of course.

image attached on roughly where the form needs to go.

Habilidades: PHP

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Acerca do Empregador:
( 37 comentários ) portsmouth, United Kingdom

ID do Projeto: #548441

Premiar a:

LloydesignStudio

Hi lets start. thank you. Lloyd

$30 USD em 1 dia
(160 Avaliações)
6.3

19 freelancers estão ofertando em média $33 para este trabalho

sristerweb

Let me start.

$35 USD in 0 dias
(276 Comentários)
8.1
jexplorer

Please check pMB.. jexplorer

$30 USD in 0 dias
(164 Comentários)
7.1
DesignSolutionSW

Please check PM.Thanks.

$30 USD in 0 dias
(63 Comentários)
7.0
dagdya99

Lets start

$30 USD em 1 dia
(162 Comentários)
6.8
techcity

Please view PMB for details. Thanks.

$45 USD em 1 dia
(26 Comentários)
6.7
jsinfoway

Lets get it done.. Thnx JSI Team

$45 USD em 1 dia
(72 Comentários)
6.6
inspirad

Hi, I am interested. Please select me as your service provider. Regards, Inspirad

$45 USD em 1 dia
(68 Comentários)
6.2
barca2045

I can do it really quickly

$30 USD in 0 dias
(52 Comentários)
5.5
kingyond

please check PMB.

$31 USD em 1 dia
(9 Comentários)
5.3
offacc

Please check PM for details.

$30 USD em 1 dia
(45 Comentários)
5.1
sat12345

Plz check PMB..

$30 USD em 1 dia
(51 Comentários)
3.9
sas05

sir please check the PM.

$30 USD in 0 dias
(10 Comentários)
3.3
rehaanron4u

Ready to start :)

$30 USD in 0 dias
(19 Comentários)
3.2
cheapndbest

I am ready please check PMB,Thanks

$30 USD em 1 dia
(3 Comentários)
2.2
BestForever

I can do it. please select my bid. thanks

$30 USD em 1 dia
(2 Comentários)
1.9
progressiveway

Ready to start, please check PMB for more detalis.

$30 USD em 1 dia
(1 Comentário)
1.4
uniquelogics

HI, I am ready to finish it in one hour. thanks

$30 USD em 1 dia
(0 Comentários)
0.0
indianexpert

ready to start...

$30 USD em 1 dia
(0 Comentários)
0.0