Interactive Online form to database development

Need an interactive web page that will collect information from people who are in need of a mortgage loan in the United States. The form needs to resemble this link: [login to view URL] the rest of the page should allow for banner or generic company logo and labeling as well as send the information to a database after the consumer completes and hits send. The web page should provide a secure protected environment and ease the consumers mind about the personal information that is posted and sent. The sent information should populate an access or SQL database and allow for queries and reports to be run easily through a web based administration application and not through a closed end software based application. In other words the admin should be able to log into another section of the website and view and run reports on any one or more fields that are specified through the web based database page. The results would display on the web as well and allow for printing, PDF or emailing to clients. ALso want an email sent to me each time the database received new submitted material from the customers. I have attachments on word of how the database results should appear on the website. [login to view URL] Potential for 6 more projects for reliable programmer who works with us well. ## Deliverables Complete and fully-functional working program(s) in executable form as well as complete source code of all work done. Need to sign a disclaimer form waiving all rights to program and form you develop as well. ## Deadline information I need the online form/page and database completed, tested and finished within 10 days.