HTML form with email

Create two html pages, one with embedded PHP script to email form data. The first page is a form with 21 fields. Five of these fields use drop-down menus. All data must be trimmed of leading and trailing white spaces; three of the fields must be validated for length (character count). Most require one field per row except telephone-number (4 fields in one row), cell-number (3 fields) and fax-number (3 fields). The second page displays (for review) the data entered in the form and, when activated by the user, emails the data to a specified email address with an embedded PHP script (using SMTP server “[login to view URL]? or other method of your choice). The fields are: Item#* Quantity* PO# Name Title1 Title2 Title3 Address* City* Tel-areacode, Tel-prefix, Tel-body, Tel-ext Cell-areacode, Cell-prefix, Cell-body Fax-areacode, Fax-prefix, Fax-body Email Web* Of these, Title1, Title2 and Title3 must have no more than 20 characters. Fields marked with “*?? use a drop-down menu of choices. For the sake of this project, use generic data for the menus and we will enter specific data later. ## Deliverables 1) Complete and fully-functional working program(s) in executable form as well as complete source code of all work done. 2) Deliverables must be in ready-to-run condition, as follows? (depending on the nature? of the deliverables): a)? For web sites or? other server-side deliverables intended to only ever exist in one place in the Buyer's environment--Deliverables must be installed by the Seller in ready-to-run condition in the Buyer's environment. b) For all others including desktop software or software the buyer intends to distribute: A software? installation package that will install the software in ready-to-run condition on the platform(s) specified in this bid request. 3) All deliverables will be considered "work made for hire" under U.S. Copyright law. Buyer will receive exclusive and complete copyrights to all work purchased. (No GPL, GNU, 3rd party components, etc. unless all copyright ramifications are explained AND AGREED TO by the buyer on the site per the coder's Seller Legal Agreement). ## Platform Unix or Linux server with PHP