Urgent Help Please Possible PHP, ASP, JavaScript, Ajax Help. Order Form.

Hello Guys! I really need some help on this one. Ok so here is what I need. I want to reproduce some order form I found on a website while I was browsing. I'm not sure if it's PHP, ASP, JavaScript, Ajax or any other scripting language. And basically I'm not that good at any of thos so I would really need some help from you guys. Here is the page where the form is : Click here!

Well as you see at first there are 2 boxes, one with States and one Entity. And when you choose them down the page will apear a order form. I need both the selectors and form. So please if anyone could help me I would be so grateful. 

Thank You in advance!

That form is ASP according to the URL. This won't be difficult. I code in PHP and can do that for you later today.What do you need for the Form at the bottom? What fields, etc? Is there a DB to add information to? What is its structure?

That form is ASP according to the URL. This won't be difficult.
I code in PHP and can do that for you later today.
What do you need for the Form at the bottom? What fields, etc?
Is there a DB to add information to? What is its structure?

trap17___sample_for_jhaslip.doc

Well, I said I would write the script, so here it is:

<?phpif ( isset($_POST['submitted'])) {  /* do stuff here ie: validate the Form, set flags for processing */        }?><form method="POST" action="<?php echo $_SERVER['PHP_SELF']; ?>" >   <select name="state" id="state">      <option value="AL" <?PHP if($state=="AL") echo "selected";?>>Alabama</option>      <option value="AK" <?PHP if($state=="AK") echo "selected";?>>Alaska</option>      <option value="AZ" <?PHP if($state=="AZ") echo "selected";?>>Arizona</option>      <option value="AR" <?PHP if($state=="AR") echo "selected";?>>Arkansas</option>      <option value="CA" <?PHP if($state=="CA") echo "selected";?>>California</option>      <option value="CO" <?PHP if($state=="CO") echo "selected";?>>Colorado</option>      <option value="CT" <?PHP if($state=="CT") echo "selected";?>>Connecticut</option>      <option value="DE" <?PHP if($state=="DE") echo "selected";?>>Delaware</option>      <option value="DC" <?PHP if($state=="DC") echo "selected";?>>District of Columbia</option>      <option value="FL" <?PHP if($state=="FL") echo "selected";?>>Florida</option>      <option value="GA" <?PHP if($state=="GA") echo "selected";?>>Georgia</option>      <option value="HI" <?PHP if($state=="HI") echo "selected";?>>Hawaii</option>      <option value="ID" <?PHP if($state=="ID") echo "selected";?>>Idaho</option>      <option value="IL" <?PHP if($state=="IL") echo "selected";?>>Illinois</option>      <option value="IN" <?PHP if($state=="IN") echo "selected";?>>Indiana</option>      <option value="IA" <?PHP if($state=="IA") echo "selected";?>>Iowa</option>      <option value="KS" <?PHP if($state=="KS") echo "selected";?>>Kansas</option>      <option value="KY" <?PHP if($state=="KY") echo "selected";?>>Kentucky</option>      <option value="LA" <?PHP if($state=="LA") echo "selected";?>>Louisiana</option>      <option value="ME" <?PHP if($state=="ME") echo "selected";?>>Maine</option>      <option value="MD" <?PHP if($state=="MD") echo "selected";?>>Maryland</option>      <option value="MA" <?PHP if($state=="MA") echo "selected";?>>Massachusetts</option>      <option value="MI" <?PHP if($state=="MI") echo "selected";?>>Michigan</option>      <option value="MN" <?PHP if($state=="MN") echo "selected";?>>Minnesota</option>      <option value="MS" <?PHP if($state=="MS") echo "selected";?>>Mississippi</option>      <option value="MO" <?PHP if($state=="MO") echo "selected";?>>Missouri</option>      <option value="MT" <?PHP if($state=="MT") echo "selected";?>>Montana</option>      <option value="NE" <?PHP if($state=="NE") echo "selected";?>>Nebraska</option>      <option value="NV" <?PHP if($state=="NV") echo "selected";?>>Nevada</option>      <option value="NH" <?PHP if($state=="NH") echo "selected";?>>New Hampshire</option>      <option value="NJ" <?PHP if($state=="NJ") echo "selected";?>>New Jersey</option>      <option value="NM" <?PHP if($state=="NM") echo "selected";?>>New Mexico</option>      <option value="NY" <?PHP if($state=="NY") echo "selected";?>>New York</option>      <option value="NC" <?PHP if($state=="NC") echo "selected";?>>North Carolina</option>      <option value="ND" <?PHP if($state=="ND") echo "selected";?>>North Dakota</option>      <option value="OH" <?PHP if($state=="OH") echo "selected";?>>Ohio</option>      <option value="OK" <?PHP if($state=="OK") echo "selected";?>>Oklahoma</option>      <option value="OR" <?PHP if($state=="OR") echo "selected";?>>Oregon</option>      <option value="PA" <?PHP if($state=="PA") echo "selected";?>>Pennsylvania</option>      <option value="RI" <?PHP if($state=="RI") echo "selected";?>>Rhode Island</option>      <option value="SC" <?PHP if($state=="SC") echo "selected";?>>South Carolina</option>      <option value="SD" <?PHP if($state=="SD") echo "selected";?>>South Dakota</option>      <option value="TN" <?PHP if($state=="TN") echo "selected";?>>Tennessee</option>      <option value="TX" <?PHP if($state=="TX") echo "selected";?>>Texas</option>      <option value="UT" <?PHP if($state=="UT") echo "selected";?>>Utah</option>      <option value="VT" <?PHP if($state=="VT") echo "selected";?>>Vermont</option>      <option value="VA" <?PHP if($state=="VA") echo "selected";?>>Virginia</option>      <option value="WA" <?PHP if($state=="WA") echo "selected";?>>Washington</option>      <option value="WV" <?PHP if($state=="WV") echo "selected";?>>West Virginia</option>      <option value="WI" <?PHP if($state=="WI") echo "selected";?>>Wisconsin</option>      <option value="WY" <?PHP if($state=="WY") echo "selected";?>>Wyoming</option>   </select>      <select name="owner" id="owner">      <option value="llc"  <?PHP if($owner=="llc")  echo "selected";?>>Limited Liability Corporation</option>      <option value="corp" <?PHP if($owner=="corp") echo "selected";?>>Corporation</option>      <option value="prop" <?PHP if($owner=="prop") echo "selected";?>>Proprietor</option>   </select>      <input type = "submit" name = "submit" value = "submit" />   <input type="hidden" name = "submitted" value = "TRUE"  /></form><?phpif ( isset($_POST['submitted'])) {    echo 'You have selected the State of "' . $_POST['state'] . '" and Ownership type "' . $_POST['owner'] . '" for your submission. <br />';   /* sample output shows the POST array values after the form is submitted (for debugging) */    echo '<pre>';     print_r($_POST);     echo '</pre>';    }?>

I really did not intend to write the entire page for you, just the drop-down stuff to select the state and Incorporation information. After the State and ownership is selected from the drop-down, and the submit button is clicked, the values are available in the POST Array for handling, as per the sample code above.Please add this into your page and if further information is required, please post back here.The assistance given here is to promote you learning the coding required to perform the task of writing your own code, not to provide a service which normally you might pay for. As for Paypal, I do not have a clue how to go about handling the payment, so you will need to continue seeking assistance on that. I suggest a Google search.

Well, I said I would write the script, so here it is:

/* do stuff here ie linenums:0'><?phpif ( isset($_POST['submitted'])) { /* do stuff here ie: validate the Form, set flags for processing */ }?><form method="POST" action="<?php echo $_SERVER['PHP_SELF']; ?>" > <select name="state" id="state"> <option value="AL" <?PHP if($state=="AL") echo "selected";?>>Alabama</option> <option value="AK" <?PHP if($state=="AK") echo "selected";?>>Alaska</option> <option value="AZ" <?PHP if($state=="AZ") echo "selected";?>>Arizona</option> <option value="AR" <?PHP if($state=="AR") echo "selected";?>>Arkansas</option> <option value="CA" <?PHP if($state=="CA") echo "selected";?>>California</option> <option value="CO" <?PHP if($state=="CO") echo "selected";?>>Colorado</option> <option value="CT" <?PHP if($state=="CT") echo "selected";?>>Connecticut</option> <option value="DE" <?PHP if($state=="DE") echo "selected";?>>Delaware</option> <option value="DC" <?PHP if($state=="DC") echo "selected";?>>District of Columbia</option> <option value="FL" <?PHP if($state=="FL") echo "selected";?>>Florida</option> <option value="GA" <?PHP if($state=="GA") echo "selected";?>>Georgia</option> <option value="HI" <?PHP if($state=="HI") echo "selected";?>>Hawaii</option> <option value="ID" <?PHP if($state=="ID") echo "selected";?>>Idaho</option> <option value="IL" <?PHP if($state=="IL") echo "selected";?>>Illinois</option> <option value="IN" <?PHP if($state=="IN") echo "selected";?>>Indiana</option> <option value="IA" <?PHP if($state=="IA") echo "selected";?>>Iowa</option> <option value="KS" <?PHP if($state=="KS") echo "selected";?>>Kansas</option> <option value="KY" <?PHP if($state=="KY") echo "selected";?>>Kentucky</option> <option value="LA" <?PHP if($state=="LA") echo "selected";?>>Louisiana</option> <option value="ME" <?PHP if($state=="ME") echo "selected";?>>Maine</option> <option value="MD" <?PHP if($state=="MD") echo "selected";?>>Maryland</option> <option value="MA" <?PHP if($state=="MA") echo "selected";?>>Massachusetts</option> <option value="MI" <?PHP if($state=="MI") echo "selected";?>>Michigan</option> <option value="MN" <?PHP if($state=="MN") echo "selected";?>>Minnesota</option> <option value="MS" <?PHP if($state=="MS") echo "selected";?>>Mississippi</option> <option value="MO" <?PHP if($state=="MO") echo "selected";?>>Missouri</option> <option value="MT" <?PHP if($state=="MT") echo "selected";?>>Montana</option> <option value="NE" <?PHP if($state=="NE") echo "selected";?>>Nebraska</option> <option value="NV" <?PHP if($state=="NV") echo "selected";?>>Nevada</option> <option value="NH" <?PHP if($state=="NH") echo "selected";?>>New Hampshire</option> <option value="NJ" <?PHP if($state=="NJ") echo "selected";?>>New Jersey</option> <option value="NM" <?PHP if($state=="NM") echo "selected";?>>New Mexico</option> <option value="NY" <?PHP if($state=="NY") echo "selected";?>>New York</option> <option value="NC" <?PHP if($state=="NC") echo "selected";?>>North Carolina</option> <option value="ND" <?PHP if($state=="ND") echo "selected";?>>North Dakota</option> <option value="OH" <?PHP if($state=="OH") echo "selected";?>>Ohio</option> <option value="OK" <?PHP if($state=="OK") echo "selected";?>>Oklahoma</option> <option value="OR" <?PHP if($state=="OR") echo "selected";?>>Oregon</option> <option value="PA" <?PHP if($state=="PA") echo "selected";?>>Pennsylvania</option> <option value="RI" <?PHP if($state=="RI") echo "selected";?>>Rhode Island</option> <option value="SC" <?PHP if($state=="SC") echo "selected";?>>South Carolina</option> <option value="SD" <?PHP if($state=="SD") echo "selected";?>>South Dakota</option> <option value="TN" <?PHP if($state=="TN") echo "selected";?>>Tennessee</option> <option value="TX" <?PHP if($state=="TX") echo "selected";?>>Texas</option> <option value="UT" <?PHP if($state=="UT") echo "selected";?>>Utah</option> <option value="VT" <?PHP if($state=="VT") echo "selected";?>>Vermont</option> <option value="VA" <?PHP if($state=="VA") echo "selected";?>>Virginia</option> <option value="WA" <?PHP if($state=="WA") echo "selected";?>>Washington</option> <option value="WV" <?PHP if($state=="WV") echo "selected";?>>West Virginia</option> <option value="WI" <?PHP if($state=="WI") echo "selected";?>>Wisconsin</option> <option value="WY" <?PHP if($state=="WY") echo "selected";?>>Wyoming</option> </select> <select name="owner" id="owner"> <option value="llc" <?PHP if($owner=="llc") echo "selected";?>>Limited Liability Corporation</option> <option value="corp" <?PHP if($owner=="corp") echo "selected";?>>Corporation</option> <option value="prop" <?PHP if($owner=="prop") echo "selected";?>>Proprietor</option> </select> <input type = "submit" name = "submit" value = "submit" /> <input type="hidden" name = "submitted" value = "TRUE" /></form><?phpif ( isset($_POST['submitted'])) { echo 'You have selected the State of "' . $_POST['state'] . '" and Ownership type "' . $_POST['owner'] . '" for your submission. <br />'; /* sample output shows the POST array values after the form is submitted (for debugging) */ echo '<pre>'; print_r($_POST); echo '</pre>'; }?>I really did not intend to write the entire page for you, just the drop-down stuff to select the state and Incorporation information.
After the State and ownership is selected from the drop-down, and the submit button is clicked, the values are available in the POST Array for handling, as per the sample code above.
Please add this into your page and if further information is required, please post back here.

The assistance given here is to promote you learning the coding required to perform the task of writing your own code, not to provide a service which normally you might pay for.

As for Paypal, I do not have a clue how to go about handling the payment, so you will need to continue seeking assistance on that. I suggest a Google search.