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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:

Fields:

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

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İşveren Hakkında:
( 1 değerlendirme ) Medford, United States

Proje NO: #752348

Seçilen:

minus40

Sounds like my kind of project

3 gün içinde 80$ USD
(1 Değerlendirme)
1.8

8 freelancers are bidding on average $86 for this job

Georgia

I am interested.

in 7 gün içinde180$ USD
(40 Değerlendirme)
7.1
shmai

have a glance at PM. Regards,

in 3 gün içinde100$ USD
(196 Değerlendirme)
7.0
ntiersolutions

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 5 gün içinde100$ USD
(110 Değerlendirme)
6.4
InnovistaLabs

Hi, Please check pmb Thanks

in 2 gün içinde40$ USD
(2 Değerlendirme)
4.4
Cossak

You will not regret if you choose me)

1 gün içinde 30$ USD
(0 Değerlendirme)
0.0
purusinha

Please provide me the details.

in 3 gün içinde60$ USD
(0 Değerlendirme)
0.0
raj2310

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 fazlası

in 3 gün içinde100$ USD
(0 Değerlendirme)
0.0