64910 Affiliate sign-up page

I need an affiliate sign-up page created that prompts the user to fill in information and agree to an agreement that is displayed. Minor changes to the specs below should be anticated in your bid. Also, ways to make the page better than what I have spec'd is always appreciated. Information needed: individual name (required) company name (optional) address (two lines, one required) city (required) state/province (optional) country (list choice, entry required) zip/postal code (required entry, user may enter 'none' if not used) check box to indicate if company or individual pays US taxes if checkbox ix checked then entry is required in a field to specify US tax ID or social security number. Otherwise no entry in this field required If user specifies US as the country, then tax ID or social security number required) email address (double entry, address must be valid address and same in both boxes) phone number (required) fax number (optional) payment method: two choices via option button: Check on US bank or Paypal website URL (optional) comment box allowing user to describe individual business or company (optional) Scrollable box that displays a long affiliate agreement! A list box indicating several choices on how the user found out about the program. A choice is required. Choice can not be a default - visitor must choose from list Option: first choice can be "choose one" and if this is value submitted, user is advised to make a different choice. password (double entry and verification that entries are the same. minimum 5 characters) All required fields will be clearly indicated. A submit button that when clicked validates the above, returns user to page if entries missing or incorrect (and advises which are the problem). If all ok it sends an email to the user and to another email address (most likely mine). Email will contain text that I will supply and a copy of the license agreement. It will also contain all the information supplied by user. Email is to be easy to read and not jumbled up. Each user entry will be identified with one entry per row in email. Example: Name: John Doe, etc. Signup page will have the look and feel of other pages at my site, add-ins [url removed, login to view], which is simple html. Programmer will receive copy of current contact us page which uses javascript to validate input and send email from visitors to us in case this code will help in the above work. I will also put in text on the page that will describe the affiliate program to the visitor, so content on affiliate page should be easy to modify. Resulting page code should be well documented.

JavaScript Odd Jobs PHP

Proje NO: #1813261

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