Cartão Fidelidade - Create a loyalty card form.

Recebi hoje uma solicitação para a criação de um formulário para um programa de Cartão Fidelidade dos clientes de uma clínica médica.
Passei o dia tentando desenvolver esse formulário e ainda não consegui.
Podem me ajudar?

We would be glad to assist you with creating your form. If you like, you can check out our application form templates that you can use and modify to fit your requirements. 

If you need further assistance with creating the form, please let us know.
I will wait for your response.

Conseguiu construir?

N consegui!
Saudaes,
Hermano Amador
071 992 914 539
Skype: hhmano
________________________________
De: JotForm
Enviado: quarta-feira, 5 de outubro de 2016 19:50
Para: hhmano@hotmail.com
Assunto: Re: Cart Fidelidade - Create a loyalty card form.
A new response has been received:
[JOTFORM]/www.jotform.com>
[https://www.jotform.com/resources/assets/icon/jotform-icon-dark-400x400.png]
Online Form Builder JotForm
www.jotform.com
If you need online forms for generating leads, distributing surveys, collecting payments and more, JotForm is for you. Learn more about how we can help.
Answered by SamuelGermano
Conseguiu construir?
View this thread on browser Unsubscribe Thread
1475707819
...

@SamuelGermano

If you have any question or request regarding JotForm, please open new thread and provide us more details about what you are trying to achieve. 

@HermanoAmador

If you are still unable to create your form, please provide us ID of the form you are working on and explain in more details what you are trying to achieve.