Form submission script

Hi, we are hiring a developer to create a script to submit entries to an online form. Here are the data fields that are required. * e-mail * confirm e-mail * password * confirm password * user id * first name * last name * birthday * (enter captcha solution) * (check a checkbox) * (submit) If you can provide the random data to enter (first name, last name, password, user id, birthday) that would be good, but we can provide that if necessary. For the captcha solution we would like to use decaptcher or deathbycaptcha. Also, we have several e-mail domains we can use, so maybe we can use the "user id" field for the e-mail username as well. Let us know what is easier for you. This is an urgent project that we want completed this week if possible. Please provide an estimated completion time with your bid. Thanks!