pay day loan sites

Basically I want a very simple site that acts in the same way that this site does: <[login to view URL]> It needs and most importantly the online form similar to this one: <[login to view URL]> except with logo changes and a few other changes. It must have the same validation. i.e. the email address phone number should be validated you should make sure that the data is checked for completeness. i then want this information stored in a database mysql prefereably and the infomration they entered to be emailed to me and then them to receive a confirmation email and a confirmation page. I also want the customer to have the ability to download the form, the design of which i will provide. I need this extrenely urgently. It needs to look very professional as well. ## 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 ie