Form Needed Asap

Form Needed Asap
I need a simple form created with under 10 fields that can submit the supplied information into a database on another server. So I need the form to submit the date into our database when filled out by customer.

I have the web service documentation and need this done ASAP. My clients budget is $70.00 and we need to completed within 24 hours if possible.

If you have any questions, please contact me. Payment will be made ASAP once work has been completed. You can view my feedback to see, I always pay on time every time.

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