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Clone Form – 1 Hour

September 28th, 2009

I need this form in php mailer ASAP!
I need to be able to copy and paste it in a index.

I need it to look like www.max .com/maxconnect without the db error.

I need it to say:

Who Referred You:
Full Name:
Email:
Address: (white box)
Street Address:
State: (drop down with 50 states)
City:
Zip:
Phone Number:
(then have it say next, they will then be redirected to my homepage.)

I need it to have a subject and i want to be able to send it to multiple emails.

must submit demo!


Clone Form - 1 Hour

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