A One Page insertion form in php/mysql

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

Project Description:
I have a one page form which is already designed. The insertion part has to be done using php. There are 3-4 sub insertions associated with the main form.
This work has to be done in 4 days of awarding the project.
The code should be optimized and clean.
This form is just a part of a bigger project.
If the work is good, the entire project will be given to the freelancer... which may require 3-5 months of regular work.
Just quote the cost of a single form insert, the form has around 18-20 fields, and 4 subinserts with 3 fields each. The database is in sql

Skills required:
MySQL, PHP, Software Architecture
Hire myDesignFactory
Project posted by:
myDesignFactory India
Public Clarification Board
Bids are hidden by the project creator. Log in as the employer to view bids or to bid on this project.
You will not be able to bid on this project if you are not qualified in one of the job categories. To see your qualifications click here.

$ 103
in 3 days
$ 35
in 1 days
$ 83
in 3 days
$ 79
in 4 days
$ 35
in 3 days
$ 69
in 2 days
$ 111
in 2 days
$ 120
in 4 days
Hire parthuji
$ 35
in 4 days
Hire rana37
$ 40
in 1 days