Cancelado

A payment notice form

I'm a hosting provider and need a payment notice script.

Here's what I want:

1). Informations will send to my E-mail box.

2). Three pages.

3). A simple neat template.

First page includes:

1). Customer's name. (No need to separate First & last)

2). Contact E-Mail.

3). Choose a packge. (Drop down)

4). Telegraphic transfer or paypal. (Cheek box)

5). If chosed telegraphic enter your account's last 5 numbers.

6). If chosed paypal enter your paypal account.

7). Payment date, time and ammount.

Cheek: ALL FORMS MUST BEE FILLED!!

NEXT>>

Second page includes:

1). Username your want. (Max 6 letters)

2). Password your want. (Re-enter)

3). Use my domain or plaese give me a free one. (Cheek box)

4). Enter the domain for your account.

5). Use our free domain. ([url removed, login to view])

Cheek: ALL FORMS MUST BEE FILLED!!

SUBMINT>>

List all the informations.

Put a "Go back and edit to both pages" buton, Send.

I need this script within 2 days.

I'm a hosting provider and need a payment notice script.
Here's what I want:

1). Informations will send to my E-mail box.
2). Three pages.
3). A simple neat template.

First page includes:

1). Customer's name. (No need to separate First & last)
2). Contact E-Mail.
3). Choose a packge. (Drop down)
4). Telegraphic transfer or paypal. (Cheek box)
5). If chosed telegraphic enter your account's last 5 numbers.
6). If chosed paypal enter your paypal account.
7). Payment date, time and ammount.

Cheek: ALL FORMS MUST BE FILLED!!

NEXT>>

Second page includes:

1). Username your want. (Max 6 letters)
2). Password your want. (Re-enter)
3). Use my domain or plaese give me a free one. (Cheek box)
4). Enter the domain for your account.
5). Use our free domain. (yourname.ck3.org)

Cheek: ALL FORMS MUST BE FILLED!!

SUBMINT>>

List all the informations.
Put a "Go back and edit to both pages" buton, Send.

There will be changes, I need this script within 2 days.

Habilidades: PHP

Veja mais: transfer your domain, transfer the domain name, pending payment, paypal transfer time, paypal pending payment, payment pending paypal, neat letters, i want domain transfer, give me your password, give me password, give me a username and password, give a password, three form, paypal account name, edit paypal account, payment page, payment form, no payment, letters a, form mail php

Acerca do Empregador:
( 77 comentários ) Taipei, Taiwan

ID do Projeto: #19159