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Need a form created on website that can be emailed securely...
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IT & Programming > Web Programming

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  • Posted: Wed, Aug 15, 2012
  • Time Left: Closed
  • Location: Anywhere
  • Client prefers freelancers from:
    Anywhere

    You are still able to submit a proposal for this job.

    The client prefers freelancers from
    a different location.

    You're still able to submit a proposal for this job, regardless of your location.
  • Start: Immediately
  • Budget: Less than $500
  • Fixed Price Job
  • Elance Escrow Protection
  • U.S. freelancers must have W9
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I need a secure online form that people can submit securely (same form on 3 websites)

The websites are created in Joomla. There is already another form that is set up for secure delivery at:   [obscured]  /patient/form.php- so my thoughts are this would be an easy thing to create another one. Here are the 3 sites:
  [obscured]  
  [obscured]  
  [obscured]  

The new form will go on the Employment page and will replace the Employment Application pdf form (copy all fields from the pdf onto the new secure form)


I want

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Desired Skills
Joomla!, PHP
Job ID: 32758835
Proposals
Avg $ | High $ | Low $ — Show Pricing
  • Submit Date (Latest)

2Base Technologies      
One or more team members at  are verified.  Learn More
 India  |  
Strengths : CakePHP, PHP, WordPress, Joomla, Drupal, HTML5, Web Services, Adobe Photoshop CS5, Adobe Illustrator CS5, HTML, CSS, CMS, SEO, etc...
2
  |  
 0.0   |  Private   |  0 Jobs
Bid ID: 32800788  |  Submitted: Aug 17, 2012 00:53 ET 
Proposal SEALED

 Bangladesh
We are professionals in C#, PHP with several years of experience in programming field. A one stop solution for both web and desktop application....
2
  |  
 0.0   |  Private   |  0 Jobs
Bid ID: 32779351  |  Submitted: Aug 16, 2012 06:30 ET 
Proposal SEALED

 India  |  
PHP/Mysql Developer withe experience of 4 years. Also an expert in Joomla,Yii Framework, CakePHP. expertise in HTML conversion with CSS styling...
1
  |  
 0.0   |  $0 Earnings   |  0 Jobs
Bid ID: 32773547  |  Submitted: Aug 16, 2012 01:40 ET 
Proposal SEALED

I have 6+ years of experience in the field of web development. I was working with a MNC but now I want to start my own. I have started to grow...
6
  |  
 5.0   |  Private   |  17 Jobs
Bid ID: 32771468  |  Submitted: Aug 15, 2012 23:27 ET 
Proposal SEALED

 India
From last 5 years Providing quality Websites, Custom Joomla Themes, Custom Wordpress Themes, Websites Using PHP, MySQL. Experience in responsive...
3
  |  
 0.0   |  Private   |  2 Jobs
Bid ID: 32765869  |  Submitted: Aug 15, 2012 17:04 ET 
Proposal SEALED

 India  |  
I am expertise website designer and developer. Working on all programming languages and design tools.
4
  |  
 5.0   |  $285 Earnings   |  6 Jobs
Bid ID: 32760397  |  Submitted: Aug 15, 2012 13:17 ET 
Proposal SEALED

Faisal Rashid      
Faisal Rashid's identity has been verified.  Learn More
 Pakistan  |  
.
1
  |  
 0.0   |  $0 Earnings   |  0 Jobs
Bid ID: 32760253  |  Submitted: Aug 15, 2012 13:12 ET 
Proposal SEALED

 India  |  
We are a young company in Noida, India. We provide offshore software development services to our clients. We have expertise in various technologies...
4
  |  
 0.0   |  Private   |  0 Jobs
Bid ID: 32759254  |  Submitted: Aug 15, 2012 12:33 ET 
Proposal SEALED

 Australia
Salesneer is a fast-growing outsourcing, IT solutions and Consulting company based in Melbourne, Australia . We have also expertise in Web...
1
  |  
 0.0   |  $0 Earnings   |  0 Jobs
Bid ID: 32759137  |  Submitted: Aug 15, 2012 12:29 ET 
Proposal SEALED

Arthur D.      
Arthur D.'s identity has been verified.  Learn More
 United States
Extensive experience building custom applications for the web, android, and iOs. Specialize in WordPress customizations, themes, and plugins. We...
8
  |  
 0.0   |  $0 Earnings   |  0 Jobs
Bid ID: 32759134  |  Submitted: Aug 15, 2012 12:29 ET 
Proposal SEALED

Syed Yousuf      
Syed Yousuf's identity has been verified.  Learn More
 India
Winner
The most Reliable Elancer serving Employers since 2009, with 9+ years experience in PHP/MySql, Linux, Specialized in Malware Removal, Internet...
7
  |  
 5.0   |  Private   |  79 Jobs
Bid ID: 32759099  |  Submitted: Aug 15, 2012 12:27 ET 
Delivery
Within 3 days
$125.00

 India  |  
Top At Elance in Wordpress3.5 ,Wordpress Plugin Development, Wordpress E-commerceMalware Cleaner, Internet Security, Hacking, Firewall, Wordpress...
1
  |  
 0.0   |  $0 Earnings   |  0 Jobs
Bid ID: 32759019  |  Submitted: Aug 15, 2012 12:25 ET 
Proposal SEALED
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