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Build a form with on-line payment options

$30-250 USD

In Progress
Posted over 9 years ago

$30-250 USD

Paid on delivery
I need a form created for customers to type their information into on my website, and then pay for their ad insertion or annual print subscription. The website is www.moderneducation.co. The form will include: 1) First Name, Last Name (text field) 2) Address (text field, dropdown for state & countries) 3) phone number (text field) 4) email address (text field) 5) website address (text field) 6) Do you want to place an ad or subscribe to the print edition? (Pulldown) 7) For Ad: ad size (dropdown) a) Classified ad, 10 words, $10 b) 1/32 PAGE (2.4 x 1.4 inches) $25 c) 1/16 PAGE 2 columns (4.9 inches) x 1.4 inches $45 d) 1/8 PAGE 2 columns (4.9 inches) x 3.1 inches $80 e) 1/4 PAGE 2 columns (4.9 inches) x 6.3 inches $150 f) 1/2 PAGE HOR. 4 columns (10.1 inches) x 8.02 inches $275 g) 1/2 PAGE VERT. 2 columns (4.9 inches) x 12.9 inches $275 h) FULL PAGE 4 columns (10.1 inches) x 12.9 inches $500 i) FRONT PAGE AD 4 columns (10.1 inches) x 2 inches $315 j) Web only ad ([login to view URL] website & Facebook) $10 k) Other custom ad 8) Ad color pulldown (color or black & white) 9) Checkboxes: a. Create my ad for me ($15) b. I will provide ad 10) File upload button & field for ad, logo, or other images for the ad (allow multiple files) 11) Text field for custom instructions or text for Classified ad 12) Offer No. of months to run ad: l) 1 month m) 3 MONTHS (10% DISCOUNT) n) 6 MONTHS (15% DISCOUNT) o) 9 MONTHS (20% DISCOUNT) p) 12 MONTHS (25% DISCOUNT) 13) For Annual Print Subscription – Snail Mail ($15.00) 14) Add sales tax (7%) 15) No shipping 16) Offer several free options for payment a. Paypal b. Google checkout c. Amazon checkout d. Any other easy checkout option
Project ID: 6801930

About the project

3 proposals
Remote project
Active 9 yrs ago

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3 freelancers are bidding on average $271 USD for this job
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A proposal has not yet been provided
$257 USD in 10 days
4.9 (39 reviews)
6.1
6.1
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Hello sir, i am expert Web developer. i am really interested to do your work. i can done your work easily. Please discuss further details in message. Regards yillibrown
$400 USD in 3 days
4.9 (30 reviews)
4.8
4.8
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Our services includes all types of indoor & Out Door advertisement such as: Advertising (Print, Multimedia, Web,Screen & Thermal Printing) Event management Graphic design Photography Videography Product Ads Stands Billboards Bulletin Posters (Premier Panels) Mobile Billboards Website Interior Designing Sign Boards Identification Cards Corporate Gifts Besides the items mentioned, please note that we do have a whole range of ideas for. We will provide you every best service in the market. With best wishes Sincerely, Noman Ahmed
$155 USD in 3 days
0.0 (0 reviews)
0.0
0.0

About the client

Flag of UNITED STATES
Tarpon Springs, United States
4.9
54
Payment method verified
Member since Jan 28, 2007

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