php, javascript, html chained select boxes & form variables

Avg Bid (USD)
Project Budget (USD)
$30 - $250

Project Description:
Need an experience php, javascript, jquery, html programmer to:

1. Need help with the coding of a 4 level deep php chained select box (data queried from a mysql database). 3 of the select boxes have already been coded & chained. just need an inbetween select box properly chained.

2. Currently the results of the final chained select box populates a table upon selection. Need a variable created and populated in another different html form on the page (which is used to INSERT into a database).

view attached file to get an idea of my requests above.

I consider this to be a very simple job for the right programmer.

Skills required:
Javascript, jQuery / Prototype, PHP, PSD to HTML
Additional Files: img01b.jpg
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