I need a php form. It needs to have a dropdown populated by a table and a text field for a representative name. Then it needs two(2) sets of text boxes for each of following fields: Company name Address city state zip phone email fax contact #1 contact #2 For the following Categories: Alarm Systems Appliance Stores Appraisers Asbestos Removal Asphalt & Paving Contractors Attorneys Architects Banks Basement Contractor Carpet & Carpet Cleaning Chimney Cleaning Doors See Windows & Doors Eateries/Restaurants Electricians Engineers/Home Inspection Fencing Feng Shui Flooring & Floor Refinishing Florists Food Stores Furniture Stores Garage Doors General Contractors/Builders Gutters & Drainage Systems Handyman/Repairs Insurance Agents Interior Decorators Kitchen & Bath Contractors Kitchen Cabinets & Countertops Landscape Design Landscape Maintenance Lumber Yards & Home Centers Masons Mortgage Brokers Moving Companies Oil & Gas Companies Painters- Exterior Painters- Interior Pharmacies Plumbers Pool Maintenance /Pool Companies Restaurant Roofers Salons/Nail shops Septical/Well Installers Siding Companies Sprinkler/Irrigation Structural Engineer Storage Facilities / Mini storage Surveyors Termite Inspectors Title Insurance Tree Service Windows & Doors Window Treatment & Draperies OTHER And store the results in a mysql database. It needs to fit into an html page. Please see attached file for example of how the page lays out. This appears to be three tables. One to populate the dropdown, one to store a key field, the dropdown selection and rep name and a third to store a key field and the data from the rest of the form. The data in the text boxes and the category name must be included in that data table.
1) Complete and fully-functional working program(s) in executable form as well as complete source code of all work done.
2) Deliverables must be in ready-to-run condition, as follows? (depending on the nature? of the deliverables):
a)? For web sites or? other server-side deliverables intended to only ever exist in one place in the Buyer's environment--Deliverables must be installed by the Seller in ready-to-run condition in the Buyer's environment.
b) For all others including desktop software or software the buyer intends to distribute: A software? installation package that will install the software in ready-to-run condition on the platform(s) specified in this bid request.
3) All deliverables will be considered "work made for hire" under U.S. Copyright law. Buyer will receive exclusive and complete copyrights to all work purchased. (No GPL, GNU, 3rd party components, etc. unless all copyright ramifications are explained AND AGREED TO by the buyer on the site per the coder's Seller Legal Agreement).
linux, php, mysql