343412 PHP Web App

I need a fairly simple web app build and tested by October 1st. User will come to the page and fill out a form: (all fields are required) Contact Info: - First Name - Last Name - Business Name - Email Address - Phone Number Location: - Street Address 1 - Street Address 2 - City - State - Zip Code Using the zip code, the PHP will then access a database and determine which of the "terms of use" to display. users will need to select "I agree to the terms of use" check box before being allowed to click submit. If a user has not filled out the form correctly and hits submit, the form will highlight the incorrect field so that the user can correctly fill it out. Successful Submit: there will be 4 databases total; 1 - a database of zip codes, counties/corps, and terms of use(will provide a CSV file upon acceptance of bid) 2 - Database used for storing "pending" donor sites. 3 - Database used for storing "accepted" donor sites. 4 - Database used for storing "denied" donor sites. When a user successfully submits a form a notification will be sent to the appropriate county/corps contact (recipient) as well as the submitter's email, confirming that their application is "pending". The recipient's email will include a link to a page that will let them approve or deny the application. This page will require a login. This page will then move the database item from the "pending" database to either the "approved" or "denied" database respectively. All the items from the original form must remain in the final database, either approved or denied. A final email will be sent to both the submitter and the recipient confirming that their application was either approved or denied. * Unfortunately, only fluent English speaking developers will qualify for the project due to the nature of the project. Please submit a resume and a minimum of 3 urls of samples projects. * The lowest bid may or may not win the auction. * Project must be completed by October 1st.