I need someone to design and code a lead generation form for me. I need the design to be just like the yellow get a quote box at [url removed, login to view] except that I will need the design to match my site, which I will show to the winner.
I will give you code for each of the drop down choices, so that you can code it up to display the ad results, just like on that page.
This will be simple and easy, just need the box designed with a few drop down options (4, to be exact) and the zip code box, and it needs to be coded with the code I give so that when someone enters car insurance and then a zip, it accesses a certain code. When someone enters health etc..., it accesses a different code.