Custom Web Form

We have a form that we've created that passes data to another website via a simple POST. We need to display the values of two particular fileds within the same page AND pass the values along via POST when the form is submitted. For example: We have a field to enter a customer's last name. Once the customer's last name has been entered, I'd like for that value to be displayed elsewhere on the page. (i.e. Hello Mrs. . A local representative will call you shortly.) Sample code is attached. The existing page is written in php despite the html attachement. ## 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 Linux PHP IE 5+, Mozilla, Firefox, Netscape, Safari, Opera etc. (all major browsers)