The form is self-explanatory. The small diamond icons on the top right are selectable images, it is one form input. The sliding scales each return two form inputs. The ranges of the sliding scales needs to be editable. Please provide a quote and time frame. Let me know if you have any additional questions.
A similar working version can be seen here:
We are a leading website company based in India.We can do the work for you.I cannot PM you here.
We have well experienced professionals in many Web platforms such as Flash design,flyer design, PHP,ASP.Net, Vb.net,C#.net,menu Flash , HTML , CSS, Photoshop, Web designs , Java scripts, AJAX, Portal developments MY SQL, MS SQL ,MSACCESS etc. We are also in Joomla,Wordpress,Drupal and Magento technologies.
Email me back with details.I will get back to you with our portfolio.
I am interested to take this up. but please let me know, is this still available ?
If this is so please send me the complete details about your requirements. Then i will be able to tell you exact timeline & costing too.