Project Detail

Description

This is a simple job for someone who knows HTML/PHP

I need an HTML form and PHP file that will send a text email containing the user's information in a specific format, redirecting the user to another webpage upon submission.

HTML Form must contain:
Product number (hidden, default value)
Product quantity (hidden, default value)
First Name (required)
Last Name (required)
Email (required)
Address 1 (required)
Address 2 (optional)
City (required)
State/Province (required)
Postal Code (required)
Country (required, drop-down: USA, Canada)

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Email format must be as follows:
To: (specified email)
Subject: New order was placed by John Smith
Body:


Order Information

(V4081305483) X 1

fname: John
lname: Smith
address1: 123 Fourth Street
address2:
city: Los Angeles
state: CA
zip: 12345
country: USA
b_fname:
b_lname:
b_address1:
b_address2:
b_city:
b_state:
b_zip:
b_country:
phone_day
phone_night
email: user email
fax
company

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Form should be straight HTML and PHP file straight PHP. I'll provide the email address, redirect URL, order number, and site info upon acceptance of the project.