Form to save to 2 mysql databases

I want a form created to save the form fields to different mysql databases. The form will have fields like Name, Address and other similar fields and 3 special fields; Username, email and email confirmation. Now I want a php or html with php integrated to save all the normal fields to a mysql table and to save the other 3 special fields to a different table, performing a php function on them. If you understand what I mean please give me a bid price and an estimated time. If there's any misunderstanding please let me know. Thanks and happy bidding! ## Deliverables 1) Complete and fully-functional working program(s) in executable form as well as complete source code of all work done. 2) Deliverables must be in ready-to-run condition, as follows? (depending on the nature? of the deliverables): a)? For web sites or? other server-side deliverables intended to only ever exist in one place in the Buyer's environment--Deliverables must be installed by the Seller in ready-to-run condition in the Buyer's environment. b) For all others including desktop software or software the buyer intends to distribute: A software? installation package that will install the software in ready-to-run condition on the platform(s) specified in this bid request. 3) All deliverables will be considered "work made for hire" under U.S. Copyright law. Buyer will receive exclusive and complete copyrights to all work purchased. (No GPL, GNU, 3rd party components, etc. unless all copyright ramifications are explained AND AGREED TO by the buyer on the site per the coder's Seller Legal Agreement). ## Platform PHP, HTML, MYSQL