Gauge inside a form

Envato Customers Looking For
1

Hi guys,

I’m looking for a form where people can select a percentage of a service via a gauge.
It should be 5 values: 0%, 25%, 50%, 75% and 100%.
The gauge itself can preferably work as a slider, but something like this is also fine:

The form itself is a simple contact form that sends an email.
Can anyone help me with this?

2

@SalvaSalva,

Are you looking for someone to custom code it? Or how do you prefer it?