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

Ver mais: email add, send form email address, form image, send page, add address, send form, add image, form contact, php page address, php data form, contact email form, contact form database, image form, phone add, real page, send form data database, add company name, add company, form send email, company name address database, form php page, form image php, attached page, send image phone, send image email php

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