Website form that can create a user on my on-line backup server via api/php

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Nkonye O.Sandy R.Nathan B.Mat W.WIT E. + 2 others have already sent a proposal.
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Description

Experience Level: Expert
I have a online backup service software.

I am looking for help with a signup form that i can put on my website that will capture the user inforamtion (example in the image attached) and auto create a backup user via API on to my backup server and also I would like email address and other details in the form. I am not too interested in having payment method as of yet I can work on that later ( i will contact the client after the trial period via email). i would like something in php that i can integrate with my existing site. is anyone interested in doing this? If so how much would it cost?

Please check out this link www.123-backup.com/obs-admin-guide.pdf

this is the guideand all necessary api instructions to create a api for the online backup (page 69)

so if you know how to make a api call in php please let me know. good project for someone's portfolio.

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