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 menu shall open a different input field. The form will also have a credit card payment section which i can enable or disable according to requirement.
Also i need a cryptocurrency ticker which can do auto conversion to a desired amount totaling the live market. I can explain more in details once you are selected. I require professional and experienced developers only.
The markup is attached for your knowledge