81181 Online Secure Order Form CC

We are looking for someone who can take a form that we already have and create a backend for it. We will need to have the form accessable from a secure site, as it will contain Credit Card Info. All form data will have to be added to a database for later use and look up The access to the Info that is inputed will need to be also on our secured server and only be accessable via password. We have the form online, Open a PMB and we will link you to it. This should not be a hard project. We will need it to be done within a day or two.