Simple form submit to webpage needed.

1) I need a simple form with 6 input fields created. Once a user hits submits the forms inputted data should be published to a seperate webpage along with being stored in some sort of db so that the information can be edited, deleted, if needed. One of the input fields must be a field that lets a user browse their hard drive for a jpeg. One of the coresponding out puts must output the image to the left or right of the rest of the outputted input fields.

The form should be on its own administrative webpage protected by user/password. The outputted data should be on its own webpage viewable by the public.

I should be able to configure the amount of entries per webpage. Meaning 10 entries per page if needed.

Any questions just pm me. The script can be in php/cgi.

2) Payment Amount: Make me an offer!

3) Payment method/ details: Paypal

4) Additional Info (about project or potential bidders): If any questions just email me bassmastersj@gmail.com

HI, I can do this with PHP. Thanks,

Email sent.

Job completed !!