[Buying] Contact Form

[ChaosCoder]

Hey Guys, I need a Contact Form

The ContactForm should Include:

-Chained Dropdown (3 Comboboxes)
like this:

-First Name
-Last Name
-Adress (Street,Zip,City)

-E-Mail
-Mobile
(Both required, but only E-Mail or Mobile need to fill)

allowed characters for Mobile "+" "-" "/"

-Submit Button

if the customer Submit the Form i would get an E-Mail



Contact me with price.

Chaos