[Req] A Multi Field Form in PHP for Html Site

[Ben10]

Hello All

I badly need your help i request all of you please help me :S.

I want to create ha Online Inquiry from on my Html based Web site i am trying to create this from since Last 1 weak But i cant do this :S... I also try to create this From in Html with front Page but my hosting server cant Allowed Front Page Extension :S .....Now I want to create this form in PHP

I have Create This From in HTML With Front Page Extension

View attachment 8846​

Please Someone Create this From as per Field i Mentioned Bellow..

From Fields

Name :
Company Name :
Address :
Cell :
Phone :
Fax :
Email :
Project Place :
Brand Name:
Product Type :
Capacity :
Quantity :
Others Details:


and Image Verification option for submitting form

I relay need this i also try my best to create this form but my all efforts in vane :S:S:S:S:S:S:S....
Please Please some one create this for me I shell be Very Thankful to Him/Her.waiting for your kind response.

Regards
Ben

 

[Itsuki Minami]

google google google is not that hard is you just have to use the _POST option of php actually is super easy man, u____u what's the point of having internet...just google it there's a lot of form generators