Hi

I am needing some simple html/php work done. Here is what I am looking for.

I am wanting to create a replicated website like the one seen here. I am not looking for the web design really but the coding to make it replicated. I have the design for it already.

http://web.archive.org/web/20041112051900/www.eliteteammarketing.com/89283/

If you look at the end of the url you will see a unique ID that says "89283".

I am wanting to create something like this where I will have a page that all someone has to do is fill in some information and they will get a page just like this with their own unique information after they hit submit.

If you scroll down the page, you can see where a person's name, email and phone is inserted down the page. In this case
it is:

Anne Ahira
webmaster at asianbrain.com
+62 81 320.688.898

Also, on the form page, I want one of the options to have a place to add their autoresponder form code so they will get
any leads that come to the site.

Just so this makes sense...

A person will go to a webpage where they see a form asking for the following information:

Name
Email
Phone
Country
Autoresponder email code for email follow up system.

When the person hits submit, a person will get a page just like you see above that has THEIR information on it.

The autoresponder code is just a piece of javascript they will have that uses their autoresponder email system.

Please ask me any questions that you would like.

Thanks

Dave