Custom .FLV video player w/ information capture

We need a custom .flv video player built. It should have common functions such as audio control.. play.. pause.. full-screen. The one unique feature we need built is an information capture system (example is pictured above). After the video is done playing, an information box should appear where visitors can enter their contact information which is then stored in a text file on our FTP. We will be doing several of these on several different sites, so the content should be easily swappable (the video) and the text-file databases should generate themselves easily. The text-file databases must be protected so that visitors cannot access the information by decoding the SWF. **Experienced Flash and actionscript programmers only please. Please send your portfolio along with your estimated completion time with your bid.** Thanks