Need help with a subscription Form

I want to create a FORM that will allow my customers to susbcribe to my website automatically. They will choose their own username/password Details to follow. ## Deliverables 1) Complete and fully-functional working program(s) in executable form as well as complete source code of all work done. 2) Installation package that will install the software (in ready-to-run condition) on the platform(s) specified in this bid request. 3) Complete ownership and distribution copyrights to all work purchased. ## Platform All Explorer versions. ## Deadline information Must be up and running by 11/25/02