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Job icon PHP Validated Secured Sell Order Form + Cyptocurrency ticker with converter

5 Bids Posted: Jun 8 (Closed for bidding)
I require a PHP Secure Validated Sell Order Form but it should be stylish and unique in design. The form would contain all basics like: Full Name, Address, Phone, Email, D.o.b. Withdrawal options drop down menu. The drop down menu would be the most interesting feature. So for example Whatever option the user chooses from the drop down