Small PHP project

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Job Description

I have a small PHP web dev project I was hoping to have done, its a simple project but has a quick deadline of 2 days.

There are two pages and they are very simple, but need to work correctly. Ive attached the comps of the pages i would need. Please let me know as soon as possible if you would be able to work on this project. if you are available plz give me an estimate of hours.
Thank you,

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