Simple email/data form

Hello. I need someone to create an online form that people can go to fill out with some information, and then when they press “Submit” have a copy get sent back to my email and one copy to get sent to their email.

I have about 10 questions I need answered. See below for an example. That is just an example, and my questions will be a little different, but you’ll see the idea.

I would like to issue them a code or number or some kind of identifier (maybe even their PayPal transaction number that they will already have) so they can fill out as much info as they can, and be able to come back to that page to fill out more info when they have it. Each time they visit the page and hit the “Submit” button, I would like an updated email sent back to me. I hope I made that clear enough. You can provide me with the code that I can upload to my server. I wonder because I would like to store some info so they an come back and finish it if they need to, if I will need simple database feature for this? If so I have access to a MYSQL server.

During your development period you can put a copy up on your server so I can test it and make sure it works. I am very open to your suggestions as to how to implement this and design it.

My budget for this between 30 and 50 dollars.

Here are my sample questions….

Hello, please fill out this form, and press the submit button below. If you don’t have the answers for a particular question, just type in the box a brief note (for example info coming soon).


Name: _______________________________


eBay name: _______________________________


Topic1: _______________________________

Topic2: _______________________________

Topic3: _______________________________

Topic4: _______________________________

Topic5: _______________________________

Topic6: _______________________________

Topic7: _______________________________

Topic8: _______________________________


Domain 1: _______________________________

Domain 2: _______________________________

Domain 3: _______________________________

Domain 4: _______________________________

Domain 5: _______________________________

Domain 6: _______________________________

Domain 7: _______________________________

Domain 8: _______________________________


My ClickBank nickname: _______________________________


My Amazon affiliate name: _______________________________


My eBay Campaign Code: _______________________________


Notes: _________________________






Taidot: verkkosivujen suunnittelu

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Tietoa työnantajasta:
( 7 arvostelua ) Palm Beach Gardens, United States

Projektin tunnus: #395129