form customization

Closed - This job posting has been filled and work has been completed.
Web, Mobile & Software Dev Web Development Posted 3 years ago

Fixed Price

Budget: $40
Delivery by February 3, 2013

Start Date

December 27, 2012


i bought this scrip :

and i make my modifaction plz check this :

so what i want :
1-  i need the Date of birth works cuz wasn't there before so when i received order i have to see the Date of birth.
2-i add "Expedite" so any one chose it should be charge $25 to the total order
3- i add Terms & Conditions so the customer need to agree before order if he forget he need to got message to reminde him to agree.
4- tottal should be in the end before sumbit his order so he can see how match exactly he will pay.
5-i need to chnage the emails contetns when i make or recive order! has to be from :

First Name:
Last Name:
ZIP/Postal Code:


Case Type:
Case number:
Last Name on case file:
First Name on case file:
Date of birth:
Company name on case file:  (this fild is an option )
ZIP/Postal Code:

About the Client

(4.97) 21 reviews

United States
Santa Ana 11:28 AM

71 Jobs Posted
53% Hire Rate, 3 Open Jobs

$6,932 Total Spent
47 Hires, 2 Active

$2.89/hr Avg Hourly Rate Paid
464 Hours

Member Since Jun 24, 2010