Simple PHP/MySQL form and https hosting . . NOW

Could you create a PHP/MySQL order form page AND host it on YOUR https server IN THE NEXT 24 HOURS? Copy the format from our page: <[login to view URL]> When users press the "Buy now" button it will go to your new page on your https site. It should include fields: 1. Number of copies (drop-down 1-100) 2. Name (edit box) 3. email address (edit box) 4. re-enter email (edit box) and email an order receipt (simple, plain text) to the orderer and to us? Thanks Paul ## 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 Modern browsers