Need help for turn a paper form into an html5 form, PHP Web Programming

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Need help for Turn a paper form into an HTML5 form

I have a paper order-sheet that desires to be transformed into a responsive html5 form that submits to order.do.php. The fields need to have validation that is phone number fields should only have numbers, email address wants to be a valid email, etc

I want the HTML5 form to closely resemble the look of the original paper form. Besides before the job is complete, I will want the names giving too the input fields for reference

I have attached the word doc that wants to be translated into HTML for review

Desired Skills are CSS, HTML and jQuery


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