NyroModal Window based HTML contact form

We would like to have a contact form on our website where you click on a link on our site to bring up a form in a Nyromodal window. Validate the form on submission and send the results via E-mail. Validation should popup a message box indicating one or more fields were not complete and highlight incomplete fields with message(s) indicating what needs to be done. All of the validation and message boxes MUST take place inside the NyroModal window panel. We would also like the NyroModal based contact form to submit the data without refreshing the NyroModal Window. Our form is as follows:


First name (Required)

Last Name (Required)

E-mail address (Required - valid E-mail format)

Phone number (with formatting)

Company Name

Number of employees

Areas of Interest (check boxes)

Health & Wellness Programs

Flexible Spending Account (FSA)

Health Reimbursement Account (HRA)

Health Savings Account (HSA)

Self-Insured Health Plans

COBRA Administrative Services

Workers' Compensation

Physician Recruitment

Comments (Free-form text)

Final notes: The contact form and everything specified above MUST work inside of a NyroModal window panel. NO EXCEPTIONS and NO frames/iframes. If you are not familiar with NyroModal based windows and/or have very little jquery/ajax form validation experience do not bid on this project. Thank you.

Beceriler: AJAX, ASP, HTML, Javascript, jQuery / Prototype

Daha fazlasını gör: nyromodal form, jquery nyromodal form validation, nyromodal contact form, nyromodal window, nyromodal form validation, nyromodal html, nyromodal window based html contact form, jquery ajax html contact form, contact form nyromodal, jquery nyromodal form, nyromodal, nyromodal form submit, workers needs, windows validation popup, thank you notes, site html 5 free, self html 5, name validation in javascript, link no html 5, link html 5, javascript self, javascript recruitment, html 5 up, html 5 submit, html 5 link

İşveren Hakkında:
( 1 değerlendirme ) Medford, United States

Proje NO: #752348



Sounds like my kind of project

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(1 Yorum)

8 freelancers are bidding on average $86 for this job


I am interested.

in %bids___i_period_sub_35% gün içinde180%project_currencyDetails_sign_sub_37% %project_currencyDetails_code_sub_38%
(40 Değerlendirme)

have a glance at PM. Regards,

in %bids___i_period_sub_35% gün içinde100%project_currencyDetails_sign_sub_37% %project_currencyDetails_code_sub_38%
(196 Değerlendirme)

Hi, I am a professional web developer and have knowledge of jQuery, Ajax, modal windows etc. I have some queries. Please check your pm. Thanks

in %bids___i_period_sub_35% gün içinde100%project_currencyDetails_sign_sub_37% %project_currencyDetails_code_sub_38%
(110 Değerlendirme)

Hi, Please check pmb Thanks

in %bids___i_period_sub_35% gün içinde40%project_currencyDetails_sign_sub_37% %project_currencyDetails_code_sub_38%
(2 Değerlendirme)

You will not regret if you choose me)

1 gün içinde %bids___i_sum_sub_32%%project_currencyDetails_sign_sub_33% USD
(0 Değerlendirme)

Please provide me the details.

in %bids___i_period_sub_35% gün içinde60%project_currencyDetails_sign_sub_37% %project_currencyDetails_code_sub_38%
(0 Değerlendirme)

Dear Sir, I am interested to work with [url removed, login to view] can provide you good services as per your requirement.I have 4 years experience in Web designing. We have good knowledge in HTML, XHTML Conversion ,Div Conversion, Mo Daha Fazla

in %bids___i_period_sub_35% gün içinde100%project_currencyDetails_sign_sub_37% %project_currencyDetails_code_sub_38%
(0 Değerlendirme)