PHP Web Form with Captcha. Fills Secure Form and print or emails result.

Provide a simple PHP web form that fills out a form based on a few fields the end user fills out and then print or emails the form. We want the form to be secure from copying and editing so it needs to be displayed in a way that the user cannot capture the text to his local computer for editing. Possible the form displayed as a graphic or a not selectable/copyiable PDF section or whatever as long as the end user cannot easily copy and paste and modify the application agreement text. The form does require the inclusion of a specific captcha (reCaptcha) challenge and it requires that the email address be kept hidden. No data is to be saved. I would think that one experienced in wed page development and PHP could easily get this done in under 4 hours. I need to have this code submitted by Thursday. Full Details in the advanced section

## Deliverables

Part one of a two part project. For now I just want to verify you can provide a simple PHP web form that fills out a form based on a few fields the end user fills out and then print or emails the form. You do not have to do part later if you do not want to. We want the form to be secure from copying and editing so it needs to be displayed in a way that the user cannot capture the text to his local computer for editing. Possible the form displayed as a graphic or a not selectable/copyiable PDF section or whatever as long as the end user cannot easily copy and paste and modify the application agreement text. The form does require the inclusion of a specific captcha (reCaptcha) challenge and it requires that the email address be kept hidden. No data is to be saved. I would think that one experienced in wed page development and PHP could easily get this done in under 4 hours. I need to have this code submitted by Wednesday May 9

Create a simple web form that includes the ReCaptca Captcha and two buttons. One button prints to their printer or they click the other button that send the filled out form to our email address.

If the first part looks and work well I will probably have you complete it by breaking it into two forms and adding more fields and including the full form. I am a bit under a deadline and would like to get your code back and tested by Wednesday May 9th.

The user would fill out the form and fill in the two word reCaptcha and click the Print button or the email button. When the click either button it confirms the reCaptcha is valid and then with emails the filled out form or prints the filled out form to their local printer.

For security reasons we do not want any data they enter in the form to be saved anywhere. Once the form is email or printed no data should be save anywhere.

The email button should use the mailhide method mentioned in the following link;

<[url removed, login to view]> or similar method where the email address is hidden within the separate PHP section.

If you are not familiar with the ReCaptcha security challenge please refer to this link

[url removed, login to view]

In case it matters the site the final form will be put on is a SSL site.

The email address you can use for sending the email will be provided when the job is assigned.

I have already setup a reCapcha account and it is not limited to any one domain. The public key you will need to include in the code is

$publickey = "6xxxxx will be provided when job assigned";

What I think is the most difficult requirement (and is worth extra) is that we want the form to be secure from copying and editing so it needs to be displayed in a way that the user cannot capture the text to his local computer for editing. Possible the form displayed as a graphic or a not selectable/copy able PDF section or whatever as long as the end user cannot easily copy and paste and modify the application agreement text. If this is too difficult than possibly I can talk the manager into not displaying the form at all and only have it printed, but I doubt he will go for that option. If he will than perhaps the form does not need to be displayed and once the user clicks print the form gets filled out, but hidden and printed to their local printer and thus there is no form displayed for them to easily copy. I cannot get an answer on this till next week and would like to get started on the rest in the mean time. Possibly the form could be converted to a graphic jpg image . There are only two fields (I show them in the from below; the date and the Subscriber's Business is field _____ ) inside the form to be filed in (by code from the fields they fill-in above the form section.)

In the next phase there will actually be two forms, one that prints to their printer and one that emails the resultant filled out form to us. So each form will only have one button Print or eMail.

Include some time to possibly help me verify the code works from my side as I have not ever used any PHP code on my web site and I may need some assistance getting started.

Keep it simple and document the code in detail.

Pretty up the form a bit, but not too much and again keep the code simple and minimal so I can try to follow it. Please just create it all in a simple HTML editor (like PHP Designer, HTML-Kit, Notepad++, PSPad, or plain notepad) that won't add extra garbage.

I would think that someone proficient in web design and PHP could whip this out in two to four hours including time to assist me in verifying it works on my site.

Basically the Web Page they see will look like:

==============================

Subscription Agreement for Criminal Records (centered on page)

Organization Name:* ________Box Field they fill In_______________

Salutation:* ______________________________________________

First Name:* _____________________________________________

Last Name:* ______________________________________________

Title:* ___________________________________________________

Telephone Number:* _______________________________________

Email Address:* ___________________________________________

Web Address: _____________________________________________

Postal Address:* ___________________________________________

Postal Code:* _____________________________________________

Nature Of Subscriber Business:* _______________________________

FSA Registration Number, if applicable: _________________________

**Include the form right below. The fields are blank and we show the form so they can read it in advance

Effective as of _________________________________ , the undersigned Subscriber and Financial Risk Mitigation (UK) Limited ("FRMUK"), a UK based entity with Companies House Registration number 7543862 acting as an Umbrella Body for the Criminal Records Bureau ("CRB") agree as follows:

1. Subscriber's Business. The nature of the Subscriber's Business is _________________________________ .

2. Payment. Subscriber agrees to pay FRMUK according to its then current and published fee schedule as amended from time-to-time.

More text will go here, but not needed for this phase.

IN WITNESS WHEREOF, and intending to be bound hereby, FRMUK and Subscriber have caused this Agreement to be executed by their duly authorized officers, and the parties hereto set their hand and affix their seal on the date first written above.

Our Company Name

By: _________________________________

Its: _________________________________

Signature: _________________________________

("Subscriber")

Company Name: _________________________________

By: _________________________________

Its: _________________________________

Signature: _________________________________

Address: _________________________________

_________________________________

Phone: _________________________________

Email: _________________________________

Web Address: _________________________________

FSA Number: _________________________________

* Here is where the ReCaptcha Goes

* Here is where you can put the two buttons

PRINT or eMail

End of Web page.

Actually we will include our standard bottom of page links as we will do at the top of the form.

When they click print it then fills out the missing blanks in the form

Including the first blank where I put _* Fill In Current Date _ you need to have the code fill in the current date. Also fill in the relevant matching fields at the bottom with the data they entered at the top. For now just have it fill in the fields; By, Phone, Email, Web Address, FSA number and prints it to their local printer.

If they click eMail it fills out the form and sends the email to us for now at a test email account of <dcicomp@[url removed, login to view]>

While I hope I was clear and specific.

Dave Charbonnet

PHP Архітектура ПЗ Тестування ПЗ Веб-хостинг Управління веб-сайтами Тестування сайтів

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