Web form & MySQL DB...

Hi I need to have a web form at my website... 3-4 fields and a submit button :) The form will appear within a wordpress page, so the php function will be called to include/execute it inside the WP page. Submitted values should be stored in a MySQL DB... There will be a backend interface to view/manage the submitted data, I suggest the user interface to be under Bootstrap framework... but I'm open to suggestions as well... just need a cool looking interface, so even if its not bootstrap. There are other features to be discussed privately. Thanks for looking, Mary