Quick Contact form needed - $7.50

It needs to have these fields:

Contact Name:

Company Name:

Address:

City, State, Zip Code:

Phone Number:

E-mail Address:

URL of Business site (if have one):

Paypal Transaction #:

Listing or Sponsorship:

Features of Business:

About your Business:

URL(s) to Images:

Comments (need website, banners, etc.):

Make sure there is a place for me to edit email send to. I would do it myself but i am swamped today.

Payment paypal, first person to p/m me a working demo and send it to me gets the loot.

Thanks

 

I have pm'd you I have made on just need test email to send to.

 

Hey.

I have created one. I will PM you with my demo URL and the login for the test email.

Thanks.