signup page and ref php script

Hello I need a webpage with some input fields. Asterisk is required, if not filled an alert will inform the user of the not compiled fields. ie: "first name not filled" - fields *first name *last name company name *company | (option button) *private | (option button) *tax id *street *city *province *zip *phone *email (check if correct email format, alert in case of wrong email) bank account owner bank name account nr abi cab referrer (url parameter) *accept terms (check box) TOS (multiline field filled with terms) the script will even store the current time Once submitted the script should store the date in mysql db, send out 2 emails one to user (to the filled email) and one to me. The email content will be the content of 2 different html page one sent to the user one sent to me. The email sent to me will have the filled data inside it. I need the mysql script to create the table with all fields. The referrer field is filled automatically if a parameter is set on the url. For example if a user comes to my site with an url like [login to view URL], the field will have 015. This parameter will pass through each page of the site, if the user will navigate around, and when it goes on the signup page the parameter will be placed in the referrer field. Please let me know if you have questions Thanks ## 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, mysql, Internet Explorer, Mozilla Firefox