364524 Data Capture/Form Submit

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Project Description:

Landing page for loan offer:

User will be directed to my landing page (this can be designed by someon else if needed) where they will need to fill out certain information (First Name, Last Name, Birthday, email, etc).

After the user fills in information and clicks on the submit button it will need to be stored in a mySQL database.

User will need to be taken to another page thanking them for filling out the form and notifying them that they will be contacted.

This information that was collected when then need to be submitted to a website that I am a affiliate of (it will need to auto fill and submit the data that was originally collected. This does not have to be instantously and if possible done by a script I run manually or by a cron job (I should be able to choose what gets submitted and what does not).

For those bidding explain please explain how you would do this (I can be sent a Private Message).

I was thinking of going to the PHP route:

Method
Action URL
OptionNames (i.e. name of textboxes or Radio boxes etc)

But have done research it it looks like Perl may be an option

Chosen bid will be provided list of fields that are needed. My affilate would be added later on so changes or additions would have to added (maybe via a admin panel).

Skills required:
Anything Goes, MySQL, PHP
About the employer:
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