Info request form with affiliate program

PHP based form will be used to send information to several emails, tracked by me, emailed persons, and affiliates, using login/pass. 1) User fills out form on site. User selects recipients using check box. User clicks submit. Info filled out emails to recipients, and notifies me it was filled out. 2)I login and view info filled out. 3)recipients also may login using their personal login/pass to view forms sent to them. 4)Affiliate sites add form to their site using my db and can track submissions from their site using login/pass for them as affiliate. Current form I have is here: [login to view URL] New form will be directional. If user selects option A from dropdown box, only clients 1,3,5,8 show up on the email to list. If user selects option b from dropdown box, then all clients show up on email to list. If user selects option C, they are redirected to page saying they do not qualify. All submissions must be viewable in db by company who recieved them, as well as by me, and by affiliate site where form was submitted. submission form must be able to plug into other websites using that sites header and footer only, and be a 100% graphically pleasing. Login statistics/data section must fit my header footer and be graphically pleasing AND user friendly. Examples of similir work are a necessity as I've been misled here before. ## 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 must be in PHP. Must be using mysql db.