Hi-
I need a web form created that takes in the same information as the two PDF's that are attached. The form can be a simple web page without any graphics, I can format it later. I want someone to create the form and make it work so that it sends the form to an email address. The email that is sent should be formatted nicely and the questions should be in the same order as they are on the PDF's (starting with [login to view URL]). I think it should be in Arial font size 10.
PHP would be preferred.
Thanks for your time.
## Deliverables
1) Complete and fully-functional working program(s) in executable form as well as complete source code of all work done.
2) Deliverables must be in ready-to-run condition, as follows (depending on the nature of the deliverables):
a) For web sites or other server-side deliverables intended to only ever exist in one place in the Buyer's environment--Deliverables must be installed by the Seller in ready-to-run condition in the Buyer's environment.
b) For all others including desktop software or software the buyer intends to distribute: A software installation package that will install the software in ready-to-run condition on the platform(s) specified in this bid request.
3) All deliverables will be considered "work made for hire" under U.S. Copyright law. Buyer will receive exclusive and complete copyrights to all work purchased. (No GPL, GNU, 3rd party components, etc. unless all copyright ramifications are explained AND AGREED TO by the buyer on the site per the coder's Seller Legal Agreement).
## Platform
PHP form