Add to my page code generator

In a few days I will launch a new website. For this project I need a very simple piece of work. Webmasters can add their site to my page with a direct link with the following structure: [login to view URL]{url}&page={url}&title={title}&img={url} To make this a bit more user-friendly I want to make a tool that generates this code from a 4 textboxes for url, page, title and img that generates a code that web masters can add to their website, more or les like this tool: [login to view URL]