Simple Website with MySQL

I am looking to create a website with a fairly simple process and which extends and/or customizes some functionality I currenty have. I have attached a simple flow diagram to layout what I am looking for with some screen shots. The basics are as such- Client Lead gets a mailing with a PRIVATE ID (I handle this offline) Lead goes to website enters ID. Website then customizes some text and populates some data fields by pulling the associated data from a pre-populated MYSQL db. Lead finishes inputing data and submits form. I currently have a third party tool ([[login to view URL]][1]) which is used to submit the form. See attached html file for example. You can play with this form to see how it works. If you want to use this form for testing to see how it works, use 2871 N Speer Blvd, Denver, CO 80221 as the address. In the end I need to submit the appropriate data to the form as it kicks off some other backend processes. I want to create a new generic front page which simply accepts the PRIVATE ID like in the attached doc file. Then I want to perform the following updates once the ID has been entered. My first thought was to customize and extend the existing 3rd party form for this specific purpose. I would like to add some customized text to the page based on the PRIVATE ID and also pre-populate the form data fields based on the PRIVATE ID. I also want to be able to remove my picture, logo, and other identifying details so it is a generic site. ## Deliverables If it is not possilbe to customize the existing form then I am willing to create a new page which captures all the information and then passes it to the main homeinsight form for processing so the backend process still gets kicked off. I would also like to capture the leads name and email and pass it to an Aweber form to be added to another list. I attached another file which included the aweber script. Finally I would like the record in the DB to be marked so I know which ones have been requested. I have attached the snip of code for the main homeinsight form - MarketSnapShot [login to view URL] as well as the aweber scripts - Aweber [login to view URL] Please PM me with clarifying questions. Please let me know how much you would bid for this project as well as what your time frame for completion would be. I want to end up with all the necessary files and code to upload to my own site. This will be hosted on a goddady site with basic Economy hosting service. See this link for details of what is available. <[login to view URL]> To clairfy. I will provide all the necessary data into the DB. You just need to write to code to retrive it. I have uploaded an excel file which gives a sample format of how the db and data will look; I understand the hijacking the homeinsight script for customization may be difficult if not impossible. So as I mentioned I am open to creating a whole new form to capture all the information: First Name ( Taken from DB) Last Name (Taken from DB) Address (Taken from DB) City (Taken from DB) State (Taken from DB) Zipcode (Taken from DB) Email (user entered) Phone (user enterd) Seller or Buyer (Forced to be Seller) Home Type (Drop Down Choice by user) Bed (Drop Down Choice by user) Bath (Drop Down Choice by user) Square Foot (Drop Down Choice by user) Looking into the script of the actual homeinsight form I see the following - form action="[login to view URL]" method="post" name="MSRequest" ID="Form1" onSubmit="return submitWidget();" And can see all the input fields that would need to be filled in appropriately. So if we could create a new page, have the user input their data, and then call their [login to view URL] file and/or submitWidget() then maybe this is a better approach. I am open to the cleanest approach.