Data collection form and database

We need to have a web page that allows us to collect information from people that are driven to that web page.

We will need all the standard contact information plus about 10 check fields( or radio buttons), 10 additional regular fields and 2-4 text(memo) box fields.

The form (Landing web page) should be built to look like the following page [url removed, login to view] with the data entry going in the white box (all the text and pictures can go away) and should have captcha support to elimnate spam and the system should have an auto reply once the user completes the form and is accepted for processing, thanking them for participating in this endevor. I want to build the basic functionality and we will tweak the field and form text later.

We then want to put this into an online directory (Same look and feel as the web page above) that has basic search capabilites as well as the ability to export all the data to and excell spreadsheet. (the export functions are not shown on the webpage) We should also have import capabilities too. This will be hosted on Godaddy Windows hosting and you will handle the install and testing of this project. We would like them to have to login in to see the directory, so when they complete their data entry, they would get coule login later with that same email address and password. They could also have the ability to change their data at after they login in and before the go to the directory display page.

Standard contact info Includes:




Address 2 (secondary address info)

Address 1 (Primary address line)







Email Primary

Email Secondary

Additional Text Fields labelled (Text1-Text10) for now

Additional Radio Buttons labelled (Selection1 - Selections10) for now

One Logo Field (Should be able to hold up to 1MB graphic file in .jpg, gif, tif, png formats

Additional Memo Fields should have 2048 Character min and support MICE Editor for data entry. Base ASCII text should be stored in a hidden field and HTML or RTF should be stored in database primary memo field for display and editing.

Taidot: graafinen suunnittelu, HTML, PHP, verkkosivujen suunnittelu

Näytä lisää: we excell, web spreadsheet editor, web design online editor, web design editor online, text to html editor online, text editor logo online, spreadsheet web form, spreadsheet data entry form, radio editing, primary data, png to logo online, png logo online, png in html email, online png logo design, online logo png, online html editor graphic, online form editor, online editing logo, online data entry testing, memo graphic design, memo design, logo online png, logo online editor, logo online editing, logo for import export company

Tietoa työnantajasta:
( 15 arvostelua ) Weston, United States

Projektin tunnus: #4241516

Myönnetty käyttäjälle:


I am a Graphics/Web Designer/Developer with 8+ years of Professional experience. I specialize in CMS designs (WordPress, Joomla, Drupal, ) Ecommerce (Magento , Zencart, Opencart) and responsive themes. I Specialize Lisää

$200 USD 5 päivässä
(6 Arvostelua)

11 freelanceria on tarjonnut keskimäärin %project_bid_stats_avg_sub_26% %project_currencyDetails_sign_sub_27% tähän työhön


Your current website is hosted on same windows server? I think we will be doing it in, so that should be supported there already.

$145 USD 15 päivässä
(533 arvostelua)

ready to start Thanks

$120 USD 9 päivässä
(496 arvostelua)

Sir, I can do the project. Refer PMB. Looking for further discussions in this matter. with thanks and regards

$225 USD 9 päivässä
(45 arvostelua)

We are professional in Web Designing/Development technologies, finish your work soon, Please look at your private message.

$150 USD 10 päivässä
(38 arvostelua)

Hi, I can give you back end support entirely and execute it 100%. Thank you...

$220 USD 10 päivässä
(21 arvostelua)

Hi; I have studied your project requirement and understood the requirement. we feel confident about this project. We would like to share our experience to develop your project [login to view URL] open chat so that we can show Lisää

$100 USD 3 päivässä
(20 arvostelua)

Hi,we have thoroughly gone through your requirement. our crew is much interested to complete your job with perfection. Major objective of our team is to achieve the goal on time within budget. Thank You

$90 USD 5 päivässä
(0 arvostelua)

Hello sir, We are experienced and can do this project effectively and fulfill requirements. We can do some free SEO function also for you. Pls send me the details for further. Thanks

$122 USD 10 päivässä
(0 arvostelua)

We have 20 members team of expert designer and developer.I am in this field for more than 2 years.

$200 USD 10 päivässä
(0 arvostelua)

This is a simple project that can be delivered quickly by any developer. Please select our bid

$100 USD 7 päivässä
(0 arvostelua)