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SImple contact form

I require a simple contact form for my webpage.

This is what needs to be captured and e-mailed..... (cloning form from : [url removed, login to view])

Name

E-mail address

Confirm E-mail address

Choose Department (Drop down menu and sends to appropriate e-mail address)

Products (Drop down menu)

Message details

SUBMIT button

CLEAR button

No captcha required

** NO FLASH ALLOWED **

Must work with Safari and Firefox browsers

Delivery within 1 day of winning bid

Full escrow payment will be done as soon as project is accepted

Compétences : HTML, Java, Javascript, PHP, Design de site internet

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Concernant l'employeur :
( 302 commentaires ) Sydney, Australia

N° du projet : #1023167

Décerné à :

J0re

I can get this done in less than a day. Please check PMB.

30 $ USD en 0 jours
(7 Commentaires)
2.9

3 freelance ont fait une offre moyenne de 43 $ pour ce travail

mhanif

Hi Jason . Please Check PM

49 $ USD en 1 jour
(178 Commentaires)
6.6
Kamalkishover

Pls Check PM

50 $ USD en 1 jour
(21 Commentaires)
4.4