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Custom Contact form with ajax/jquery

I am looking to have a custom contact form created based on the attached image.

Please notice that regular form fields have been replaced with images. Also please notice the "characters remaining" function.

You will be responsible for creating the working form as well as the send function.

I can provide a PSD file to make development easier.

I need this to use jQuery/php.

Квалификация: Интернет-услуги Amazon, CSS, Техника, Javascript, PHP, Управление проектами, Архитектура ПО, Тестирование ПО, Веб-хостинг, Управление сайтами, Тестирование веб-сайтов

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О работодателе:
( 157 отзыв(-а, -ов) ) Edmonton, Canada

ID проекта: #3844768

Поручен:

zarish

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$25.5 USD за 8 дней(-я)
(9 отзывов(-а))
3.0

14 фрилансеров(-а) в среднем готовы выполнить эту работу за $118

cwsi

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$84.15 USD за 8 дней(-я)
(101 отзывов(-а))
7.3
lussaysl

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$340 USD за 8 дней(-я)
(162 отзывов(-а))
6.9
WiPage

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$127.5 USD за 8 дней(-я)
(170 отзывов(-а))
6.8
stevebryant

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$102 USD за 8 дней(-я)
(510 отзывов(-а))
6.7
MaximVolobuev

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$68 USD за 8 дней(-я)
(80 отзывов(-а))
6.4
devbavi

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$76.5 USD за 8 дней(-я)
(69 отзывов(-а))
5.0
mariusradvan

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$119 USD за 8 дней(-я)
(34 отзывов(-а))
5.0
rickmead

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$124.95 USD за 8 дней(-я)
(10 отзывов(-а))
4.3
wintechmadurai

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$40.8 USD за 8 дней(-я)
(28 отзывов(-а))
3.8
riaexpertvw

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$63.75 USD за 8 дней(-я)
(24 отзывов(-а))
3.5
ddunin

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$240 USD за 8 дней(-я)
(2 отзывов(-а))
3.0
webseoexpertsvw

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$212.5 USD за 8 дней(-я)
(6 отзывов(-а))
2.9
cristimatei

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$29.75 USD за 8 дней(-я)
(0 отзывов(-а))
0.0