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Simple 1 small landing page with 1 contact form

I am want to have one small landing page with 1 small contact form.

I own multiple domain names. When someone lands on my domain name, and if they are interested to buy this domain name then they can fill in the form and I get the email.

IMPORTANT: I do not want to host this form on all my domain names. I am looking for a solution, where I can host this form on one single website and re-direct all my other domain names to this website and the form should automatically capture the original domain name so when someone submits the form, then I should know which domain name they are interested in buying.

Form should contain following things

1. Name - text box

2. Email - should only accept valid emails

3. Country - text box

4. Contact Number - numeric only box

5. Offer - small numeric only box

6. Message - Small message box

7. Captcha

8. Send button

Taidot: PHP, HTML, verkkosivujen suunnittelu, WordPress, graafinen suunnittelu

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Tietoa työnantajasta:
( 10 arvostelua ) Melbourne, Australia

Projektin tunnus: #21924110

104 freelanceria on tarjonnut keskimäärin 132$ tähän työhön

sapotacorp

Hi sir, I am professional web developer have a look at my profile having nice ratings and reviews. We have finished 913 WordPress projects. Example: [login to view URL], [login to view URL], directbed.ca. I helped 107 clients fro Lisää

$117 CAD 1 päivässä
(1140 arvostelua)
8.9
mmagr99

I am ready to get this built for you in around 2-3 days maximum. Looking forward to get this done for [login to view URL] you!

$250 CAD 4 päivässä
(246 arvostelua)
8.6
A2Design

Hello! We're a full-cycle team of 30+ web developers. Having the required skills, we will be glad to help you with your project. We have some questions for you to clear up before we start. Please message us, so we Lisää

$350 CAD 3 päivässä
(154 arvostelua)
8.8
fourtunedesign

I read that you need a Simple 1 small landing page with 1 contact form and you already mentioned 8 fields name I can design and build a professional and attractive website for your company as per your requirements wi Lisää

$170 CAD 5 päivässä
(2653 arvostelua)
9.0
niravvirani17

here to make landing page and 1 for for you will give best and fast work for long term relation with you

$100 CAD 2 päivässä
(882 arvostelua)
8.4
arijit81

Greetings, Please check my reviews, to check my credibility. Can we discuss once? Regards, Arijit N:B: Please consider the quoted price as placeholder. Price can be negotiated after proper discussion.

$125 CAD 7 päivässä
(806 arvostelua)
8.6
linuxfreak1985

Hi, I can design and build a Landing Page plus form as i am a creative graphic and website [login to view URL] Website will responsive to all devices and I assure you quality work and timely support. Some of the Landing Page Lisää

$140 CAD 7 päivässä
(1066 arvostelua)
8.6
JamesTechnology

Hi :) how are you? "I can do it, please contact me" I checked your post and I am ready to help you to build your website. Quickly about me mate: I've been here for 5 years, average a 5 star rating. My clients range Lisää

$250 CAD 12 päivässä
(221 arvostelua)
7.5
Ahmed0666

Dear Sir/Madam, I’m a Web Developer, and I’m very interested in your job post. I have consistently delivered projects on time and under budget, which has earned me the role of a good and top rated freelancer, as you’ll Lisää

$30 CAD 7 päivässä
(378 arvostelua)
7.7
vtechiti

Dear employer, I have gone through your requirement to design and develop a website So I'm perfectly able to do this Job and I assure you that will give you quality work in less than anticipating time. Here are some Lisää

$100 CAD 3 päivässä
(753 arvostelua)
8.1
WordpressHeroes

Hi There! I can create an landing page for you with one form implemnted on all domains How you can finish your project in time and perfect? Very important is communication! Send me a message now, and we can discuss Lisää

$100 CAD 1 päivässä
(188 arvostelua)
7.4
writer075

Hi, I understand the requirements of this project and interested to discuss more in details to start working into it. I'll design and develop a simple landing page with a contact form for your domain for sale followin Lisää

$100 CAD 3 päivässä
(172 arvostelua)
7.2
chetna4php

Dear Employer, I have gone through your requirement to design and develop a Simple 1 small landing page with 1 contact form So I'm perfectly able to do this Job and I assure you that will give you quality work in les Lisää

$50 CAD 1 päivässä
(331 arvostelua)
7.3
Avinavkr

Hello sir, I have reviewed your project details and understood your requirements as mentioned above. We have team of experienced developers who can get your project done. we believe in quality work with ontime deliver Lisää

$50 CAD 2 päivässä
(166 arvostelua)
7.1
manojkhichar

Hello, Greetings of the day! I've gone through your posted job description. Could you please share the task list and specs of this project so that I can analyze them and can share my understanding over it, On that bas Lisää

$200 CAD 7 päivässä
(231 arvostelua)
7.1
Sunita0610

Hi, I'm a Web Designer/Developer . My name is Suraj. Your project description sounds interesting to me and I do have skills & experience that are required to complete this project. Relevant Skills and Experience UX/UI Lisää

$155 CAD 7 päivässä
(223 arvostelua)
7.2
ghanshyamsain

Hello mate . *** I am PHP/Wordpress/ WooCommerce/Magento/Shopify /SEO/webiste UI/UX expert*** I have read your description i am ready to work now and complete asap. So award project and share your details . Pleas Lisää

$99 CAD 2 päivässä
(226 arvostelua)
7.0
webstorm555

Hello, thanks for your good job posting. I have a rich experience of website development and design. I am always ready to accept your order and instructions and able to devote my hearts to you. If you have somethi Lisää

$140 CAD 3 päivässä
(57 arvostelua)
7.1
ethancoder1

Hi, I am skilful in all the aspects and requirements regarding the project and also gone through the details and understand what exactly you want. I'm among top 2% freelancers here so you can expect high-quality work Lisää

$250 CAD 7 päivässä
(204 arvostelua)
6.9
braineax

Hi there. I can design an appealing landing page for you just like the way you need it. moreover, we can point out all your sites to redirect on this landing page. I want to discuss complete details with you to under Lisää

$500 CAD 7 päivässä
(44 arvostelua)
6.5