Devam Ediyor

Simple Form

Can be done in ASP or PHP. Please see the below link for a requirement from our server so emails can be sent.

[url removed, login to view]

[url removed, login to view]

I need the below data fields to be turned into a form. When the form is filled out on SSL, then I need an email notification of the form being filled out sent to email@address and email2@address. The notification Email will state:

FIRST NAME LAST NAME – PHONE NUMBER - filled out the form. The data resides at [url removed, login to view] If you do not have the access codes, please contact Doug or Lauren at 555-1212.

Then I need an email sent to EMAIL ADDRESS that states:

DEAR FIRST NAME LAST NAME,

Your order was received. The information you relayed for registration was:

FIRST NAME LAST NAME

ADDRESS 1

ADDRESS 2

CITY, STATE, ZIP CODE

PHONE NUMBER

EMAIL

If this information is incorrect, please contact our office immediately at 555-1212.

Thank you,

My Company

In addition, I need the data then stored in a CSV or TXT file at [url removed, login to view] The data will continue to grow, so each time a form is filled out, it should timestamp when it was entered and then show the data.

Form Data is below – All fields are mandatory. If they are not filled out correctly, please provide a popup window via JavaScript that request the field to be filled out. The only field that is not mandatory is Address 2

First Name

Last Name

Address 1

Address 2 (not required)

City

State

Zip code

Phone Number

Email Address

Credit Card: Visa or Master Card

Credit Card #:

Expiration Date:

CVV#

Check Box for Agreement of Terms

Beceriler: .NET, ASP, PHP, Web Sitesi Tasarımı, Windows Masaüstü

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İşveren Hakkında:
( 45 değerlendirme ) pieprsville, United States

Proje NO: #126700