Web Form

I need someone to help me design a Internet Web Form. We have a Network Access Request form that people fax in to us, so we can setup their user accounts. I need to convert that page into a Web Form. I need to make required fields. I need a submit button, and when you click the submit button it prompts you for your network logon credentials. And after you submit the form it automatically emails you and another designated party. I also need the forms to be stored into a database. I'm not sure how indepth this really is. Anyone have any idea what type of time/resources are going to be involved in this?

Je bent de meest onverschillige hasj dealende hoer die ik ooit heb ontmoet.
<b><font color=green>hagedis</font color=green></b>,<b><font color=green>hagedis</font color=green></b>
Svol heeft een reusachtige worst

It's not real complex, a competant programmer could setup the entire form+database in a few hours once they knew a few pieces of information required for your site (db un/pw, email address to submit to, info to collect on form, operating system, programming languages supported, etc.) Time wise if you contracted it out, I'd say under a week. Resource wise, eh... call it somewhere between 50-150$/hr depending on the person... some webdesigners include programming at thier hourly rate and if you got one of them to do it you might get it as low as ~15-20$/hr. Shouldn't take more than 8 hours total for something that simple unless there are some serious issues you didn't mention here.

Shadus