Em Andamento

Build a form with on-line payment options

I need a form created for customers to type their information into on my website, and then pay for their ad insertion or annual print subscription. The website is www.moderneducation.co. The form will include:

1) First Name, Last Name (text field)

2) Address (text field, dropdown for state & countries)

3) phone number (text field)

4) email address (text field)

5) website address (text field)

6) Do you want to place an ad or subscribe to the print edition? (Pulldown)

7) For Ad: ad size (dropdown)

a) Classified ad, 10 words, $10

b) 1/32 PAGE (2.4 x 1.4 inches) $25

c) 1/16 PAGE 2 columns (4.9 inches) x 1.4 inches $45

d) 1/8 PAGE 2 columns (4.9 inches) x 3.1 inches $80

e) 1/4 PAGE 2 columns (4.9 inches) x 6.3 inches $150

f) 1/2 PAGE HOR. 4 columns (10.1 inches) x 8.02 inches $275

g) 1/2 PAGE VERT. 2 columns (4.9 inches) x 12.9 inches $275

h) FULL PAGE 4 columns (10.1 inches) x 12.9 inches $500

i) FRONT PAGE AD 4 columns (10.1 inches) x 2 inches $315

j) Web only ad ([url removed, login to view] website & Facebook) $10

k) Other custom ad

8) Ad color pulldown (color or black & white)

9) Checkboxes:

a. Create my ad for me ($15)

b. I will provide ad

10) File upload button & field for ad, logo, or other images for the ad (allow multiple files)

11) Text field for custom instructions or text for Classified ad

12) Offer No. of months to run ad:

l) 1 month

m) 3 MONTHS (10% DISCOUNT)

n) 6 MONTHS (15% DISCOUNT)

o) 9 MONTHS (20% DISCOUNT)

p) 12 MONTHS (25% DISCOUNT)

13) For Annual Print Subscription – Snail Mail ($15.00)

14) Add sales tax (7%)

15) No shipping

16) Offer several free options for payment

a. Paypal

b. Google checkout

c. Amazon checkout

d. Any other easy checkout option

Habilidades: Comércio eletrônico, HTML, Carrinhos de compras, Design de Sites

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Acerca do Empregador:
( 54 comentários ) Tarpon Springs, United States

ID do Projeto: #6801930

3 freelancers estão ofertando em média $271 para este trabalho

raiakanksha49

A proposal has not yet been provided

$257 USD in 10 dias
(39 Comentários)
6.1
yillibrown

Hello sir, i am expert Web developer. i am really interested to do your work. i can done your work easily. Please discuss further details in message. Regards yillibrown

$400 USD in 3 dias
(30 Comentários)
4.8
ghotbinima

Hi, here is my personal website and you can see some of project's here:[url removed, login to view] and if you like we can start discussing I want to improve my completion rate project to help you to reach the final decision. Mais

$156 USD in 3 dias
(7 Comentários)
3.7
noman2486

Our services includes all types of indoor & Out Door advertisement such as: Advertising (Print, Multimedia, Web,Screen & Thermal Printing) Event management Graphic design Photography Videography Product Ads St Mais

$155 USD in 3 dias
(0 Comentários)
0.0