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Customer service form with AJAX+DOM

I need to create a web form very similar to [url removed, login to view]

I also need to check that entered email is an email address and that "confirm email" is equal to previous field (email).

Note that you can add more "requests" in section 3.

Note that each "game" has different "component types". This connection should be easily editable (XML file is gooed enough, no editor needed).

The form should be sent via email in a well readable shape.

I do not need any graphics or design.

Deadline is: ASAP.

Skills: AJAX, HTML, Javascript, jQuery / Prototype, PHP

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About the Employer:
( 3 reviews ) Liberec, Czech Republic

Project ID: #11710068

Awarded to:


If you are agree I can add some Angular to your form to validate fields.

$25 USD in 1 day
(0 Reviews)

2 freelancers are bidding on average $20 for this job


hi, i have the necessary experience to do this, i have done a lot of tasks similar to this . i am able to do you task today ,

$15 USD in 1 day
(0 Reviews)