Need some PHP done - NOW (Will pay)

I've hired someone on here to create a small little PHP page that I need someone to update for me.

What I need: (trying not to get too descriptive to give away my info)

The page works perfectly for 1 option - just need to add a few more options on the form.

Hit me up on skype or PM if you are good with PHP and want a small project.

skype (human.seed)

Added you On Skype

please accept request so we can discuss your problem further

thanks
regards

Added on skype. ampit.xd

thanks for the replies - I have someone currently working on it. If we run into issues, I'll let you guys know.