256348 MoodalBox PHP Mysql Add Record

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Project Description:
I have an pre-existing php mysql db that I want to have the 'add record' generate a moodalbox that has all of my entry & upload fields to fill out for the about to be added new record.
(Instead of how it is now which is I fill out the data & submit from the same page)

The Reason? All of my entry fields now are spread horizontally across the page & I am running out of space on the page.

I want the moodalbox to list them vertically with scrolling so there is more room for my newly added fields.

All existing fields + the following new fields:

Check box for watchlarge flv exists or not
Check box for watchmedium flv exists or not
Check box for watchsmall flv exists or not

Check box for watchlarge mp4 exists or not
Check box for watchmedium mp4 exists or not
Check box for watchsmall mp4 exists or not

Check box for download exists or not

Ability to upload | add 3 additional new thumbnails using same system as Gallery edit uses (Ability to browse select upload & see the uploaded file)
1st uploaded thumbnail address will go under field imgname, 2nd under imgname2, etc.,

After submitting 'add record' from moodalbox it disappears & parent page refreshes | updates showing new record.

Moodalbox should be laidout & look very close to provided screenshot with different text fields of course.

Please give me an accurate time schedule. Thank you for bidding *

Skills required:
AJAX, Anything Goes, MySQL, PHP
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Hire claudiurogoveanu
$ 100
in 2 days