Forms and simple database project

Avg Bid (USD)
Project Budget (USD)
$250 - $750

Project Description:
Our company sells a subscription-based service (the customer pays monthly) which requires the customer to sign documents, fax them and send them back to us. We would like to replace this manual method with a form system which works as follows:

1) User reads a terms and conditions page;
2) User checks "yes" to accept t&c;
3) User types name to constitute signature;
4) User enters last four digits of social;
5) Data is inserted into user's existing record logging the above, plus date and user IP;
6) Simple web lookup tool is created (no graphic design needed) in which we can search for a user and make sure they've submitted their acceptance of our t&c.

Skills required:
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