Form Lead Generation

Lead Generation form with 15-20 supplied field names / values – needs to GET data passed via URL and needs to POST data to supplied URL. Need design as well.

Form Notes:

Birthdate must post as MMDDYYYY (ie: 01181970)

Phone # must post as 10 continuous #s (ie: 1234567890)

...

Should automatically populate City/State when user enters zip code

Should give drop-down of states and POST 2 character code (ie: CA for California)

Details

Will need ability to POST to multiple locations at the same time. One location will be on the same domain and the data should insert data in to a MySQL database, and a cookie/session should be set. A random user id should also be created and stored at this time, and this value will need to be passed on as well.

All this data will POST to an external page / url which I'll supply.

From there the data will be passed to a coreg path (I will handle this part) and once the user is complete they will be forwarded back to a final page. Post reading verification question one - in MySQL what is the difference between an inner join and a left join.

The final page will also need some basic design / CSS on it and it will be on our domain and should still have all the data stored from the original POST when the cookie/session was created – this page will be full of links that will need to have that data passed to it as well.

Project Notes:

Needs to not allow user to submit unless all required fields are filled out. Needs to tell them which fields they forgot to complete.

Question two - what hours EST do you normally work?

Needs to be secure from SQL injections

Please send the answers to the two short questions included above in a private message along with your bid. Do not post the answers publicly with your bid. This is to ensure you read the post. Bids without pm'ed answers will be ignored.

HTML Java JavaScript MySQL PHP

Project ID: #941032

About the project