Project Detail

Description

I am looking for someone to develop a form that will be used on a website by customers.

They will fill in the form which will have drop down boxes and areas to put in their details (I have a graphical illustration of the form page that I need)

I need:
1- a order page (this is where the form will be)
I need specific checks on the for as only specific details are allowed to be entered
I need a good admin section to control features on the form
2- a success page (the message can be changed in the admin controls)
3- I need emails sent to the customer and to and additional email addresses added in the admin control panel
4- spam filter
5- form encryption
To give you an idea of what I want im including the main details that need to be inputted
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EMAIL ADDRESS

CONTACT NAME

ADDRESS LINE 1

ADDRESS LINE 2

ADDRESS LINE 3

TOWN / COUNTY

POST CODE

CONTACT NUMBER

DATE OF COLLECTION

CONTACT NAME

ADDRESS LINE 1

ADDRESS LINE 2

ADDRESS LINE 3

TOWN / COUNTY

POST CODE

CONTACT NUMBER

WEIGHT(kg)

I AGREE TO THE TERMS & CONDITIONS
AND CONFIRM THE SUBMITTED DETAILS ARE CORRECT
(CHECK BOX)