34995 PHP paypal order form

I need a paypal order form which will allow users to pay for banner ads on a site. The form will capture the users name, email, banner type from a dropdown list and contain a banner upload field. The script will upload the users banner to a location on the server. Once the transaction is completed through paypal the user will be presented with a thank you page. The script will also send out a confirmation email to the user and to the site admin. Script should have a header and footer file so that we can integrate into our existing site. The script will track each purchase in a table so that we can track when a banner was purchased and when it will expire. Purchase options will be stored in a database table. An admin page will allow us to view existing purchases and add and modify banner purchase options. The script configuration file will store paypal email account and contact email account, and database connection information.