Paypal Reservations Form 3

Paypal Reservations Form 3
I need a simple reservations page with basic options:

first, last name
city
email
(captcha)

reservation field:

select dive shop: (x) Any ( ) Cabo Pulmo Divers ( ) Pepe;s ( ) Pilu&Henri ( ) CP Watersports ( ) Miguel’s ( ) CP Eco Adventures ( ) Ricardo’s

(x)first dive day (month) (day) number of divers ( ) number of snorkelers ( )
(x)second dive day (month) (day) number of divers ( ) number of snorkelers ( )
(x)third dive day (month) (day) number of divers ( ) number of snorkelers ( )
(x)fourth dive day (month) (day) number of divers ( ) number of snorkelers ( )
(x)fifth dive day (month) (day) number of divers ( ) number of snorkelers ( )

(button: Process my reservation)

this creates a (paypal) confirmation page, containing calculation
of number of divers/snorkelers/number of days = 12% of total cost deposit
and then sends a paypal money request to customer with the details
containing the link to follow by which to pay or create an account and pay.

copy of email form sent to me, site admin.

some tweaks and changes in the above form pending

place your bid based on 2 work hrs.

thanks
JMS

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