Build a webform for website

I need a Web Form that can capture Customer Info.

If the service is available in the city - the customer address needs to be pinned to a Map and logged.

According a Geo-Fence created based on suburb's availability for the cities the status of the suburb must change color based on % Sign Up.

There are two sign up options. Interested , Interested - Secured. Interested - Secured must direct to a contract page and then a payment gateway where the customer can pay to secure his spot.

The Customer info also needs to be passed via API to a management system and logged as a lead or lead - PAID.

Additional development will be required as the product set grows.

Data Field and API info will be made available per request

Here is a bit more info and example as well as API link
The map can work almost like this:
or Example2 :
API link :

Skills: HTML, Javascript, PHP, Website Design, WordPress

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About the Employer:
( 0 reviews ) Johannesburg, South Africa

Project ID: #18157516

76 freelancers are bidding on average $18/hour for this job


Hi Alexander B., We have reviewed your reference websites 'frogfootfibre', '[login to view URL]' and API link. We're team of expert web developers with over 13 years of experience in Web development. So, We can definitely h More

$15 USD / hour
(903 Reviews)

Hi, I understood your requirement and I will create your web form at all goods. Please see our Freelancer profile for past track history, we have a good track record with More

$15 USD / hour
(502 Reviews)

Hello, I have read your job and believe I will be able to assist you for your project. Available for immediate discussion, Let's proceed and work together. Thank you.

$15 USD / hour
(899 Reviews)

Hi there, I am a certified WordPress developer…I have a huge experience in PHP, CSS, HTML, Bootstrap, java script, Java query and Woocommerce etc…I can do this job... Please have a look of my previous projects... More

$16 USD / hour
(479 Reviews)

Hi, I have reviewed requirements and understand you want a web form developed to capture customers information and an api to passed the same capture information to the management system and proceed further as per ha More

$15 USD / hour
(206 Reviews)

Hi, Greetings from Votive Technologies!! As per your requirement, you want to develop a Webform on website to collect the data’s of customers with required fields of address & show on the Map, the customer add More

$15 USD / hour
(529 Reviews)

Hey, I am Salman and I will be quite delighted to assist you with your website project. I am sure before you talk any further, you would like to see my work first. - [login to view URL] - https://smartd More

$15 USD / hour
(296 Reviews)

Hello there! You are welcomed by a professional and developed team "Webcapitan". We will be glad to cooperate with you and create a Web Form that can capture Customer Info all in accordance with your needs, desires and More

$22 USD / hour
(241 Reviews)

Hello, we are interested in develop webplatform. Glad to discuss more detailed. Please, review our experience here - Waiting for Your valuable response via Fl chat. Reg More

$16 USD / hour
(213 Reviews)

Hi, hope you are good. We have read the description and we completely understand your requirements. We have all the tech skills which are essential for your project. We have successfully done similar projects for our p More

$22 USD / hour
(134 Reviews)

Hey there , I am ready to start work . i have fully confident to make for you webform for website based on your requirement . so lets discuss related requirement and make deal with it . You can check my exper More

$15 USD / hour
(526 Reviews)

Hi, We are ready to create the form. Please provide me the form details. We have some question regarding your project requirement -------------------------------------------------------------------------------- More

$16 USD / hour
(494 Reviews)

Hi There! With the reference to your description, I would like to inform you that we are the most eligible freelancer here with whom you can discuss this project. After our discussion, I am sure you will love t More

$16 USD / hour
(207 Reviews)

Yes sure I will provide you build website form for website I am having more than 10+ years of experience in website design and development Top rated developer on for website design and developmen More

$16 USD / hour
(154 Reviews)

Ready to work with you, could you please send me some more details about your project so we will estimate it accordingly....

$15 USD / hour
(444 Reviews)

Hi, We read the project description that you want us to create Online platform which can deliver useful information to Customers. Sharing you some of application link which we have done .please have look h More

$22 USD / hour
(47 Reviews)

Hi, Hope you are doing great! We can provide you the required work. We evenly have experience with Geo Fencing which we have coded in a project based on vehicle tracking. Please preview the link: [login to view URL] More

$20 USD / hour
(125 Reviews)

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$22 USD / hour
(204 Reviews)

Hello, Hope you doing great !!! As a highly skilled developer, I am full time available to work on your project and I will deliver the quality work to you. I have experience and confidence to lead your project an More

$15 USD / hour
(101 Reviews)

Hello, We are Sphinx Solutions, a rapidly growing software, mobile app development company. We create beautiful, innovative and productive websites, apps, web app for entrepreneurs & enterprises We have gone thro More

$15 USD / hour
(17 Reviews)