Create a simple web page (repost)

Create a simple web page that accepts 3 text fields as follows: Name: email: city: and create 2 action buttons as follows: "submit" and "reset" Upon hitting "reset" the 3 text fields contents should be cleared. Upon hitting "submit" an email should be generated and sent to the email address given in the email text box along with a CC to the same address (to and cc addresses are same as email text field). the subject is as follows: Confirmation Number:YYYYMMDDhh24miss - Thank you body: "Thank you for the online request. Some one will contact you shortly. Please use the above confirmation number for all future correspondence. Thank you." ## Deliverables 1) Complete and fully-functional working program(s) in executable form as well as complete source code of all work done. 2) Deliverables must be in ready-to-run condition, as follows (depending on the nature of the deliverables): a) For web sites or other server-side deliverables intended to only ever exist in one place in the Buyer's environment--Deliverables must be installed by the Seller in ready-to-run condition in the Buyer's environment. b) For all others including desktop software or software the buyer intends to distribute: A software installation package that will install the software in ready-to-run condition on the platform(s) specified in this bid request. 3) All deliverables will be considered "work made for hire" under U.S. Copyright law. Buyer will receive exclusive and complete copyrights to all work purchased. (No GPL, GNU, 3rd party components, etc. unless all copyright ramifications are explained AND AGREED TO by the buyer on the site per the coder's Seller Legal Agreement). ## Platform Use Windows , HTML, Javascript, IE 3+ versions and netscape