Form to Admin Area

I had this program before but lost it so need another freelancer to do this quick and cheap. I require a form for a DJ with fields: *(Required Field) Song title you wish to request: [Text Box] Artist: [Text Box] Do you wish to dedicate this request ? [Text Box] You must also create a simple admin area where the the form posts the request to. So once the form is processed all of the info goes into an admin area - in effect creating a request list. The songs must have a link next to them saying "Request Played" which once clicked the request is deleted. I payed something like $25 to the last freelancer on a different freelance site and he made a brilliant job. Hope to get the same service this time! Thanks