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Simple asp contact form  

Simple asp contact form is project number 442734
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Status:

Selected Providers: ITservice

Budget: $30-250

Created: 05/29/2009 at 11:25 EDT

Bid Count: 71

Average Bid:
N/A

07/28/2009 at 11:25 EDT

Project Creator: Virtualx7
Employer Rating: (No Feedback Yet)

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Description

Hello,

I am looking for somebody to create a simple contact form and have the information send to my e-mail address.
My website is hosted through Microsoft Office live websites so it needs to be done using ASP. I think.

Please find enclosed an image with the exact contact form that I need. I will need the same exact form in two different pages on my website.

Fields are:

Practice Name:
City:
Phone:
Email:
Contact Name:

Submit

All the fields need to be validated.
I need this done as soon as possible.
Please let me know time estimate for this,
Thank you.
AFMA


Additional files submitted:
contact_form.jpg

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