Hello. My name is Sundy and I'm a new freelancer starting just today :)
However, I have 9 years of working experiences in web development and my current office job requires me to work with Javascript, jQuery, Ajax and PHP. From the requirement of your task. I will be able to finish it in half day. Even if I'm new, you can put your faith in me and I will give free service on follow up changes if you have any like wanting at add another field to your form. Thank you for your time and wish you have a lovely day :)
Regards,
Sundy