81350 PHP / MYSQL - form/email

Two Form Pages with Email Functionality Page 1 = Apply Now Accepts general information about the client. First Name, MI, Last Name, Street, Apt, City, State, Zip, Home Phone, Email, SSN, Referral Rep # (referral rep validation... must be present in the database) (Customer ID automatically generated = First Initial + Last Initial + Last 4 digits of SSN) (When moving to Page 2 - the name is remembered from page 1 and shows a statement like "Congratulations [name here] you are ready to enter your payment information" Page 2 = Payment Information (secure server) Accepts Checking Account or Credit Card information Option to purchase the Business Opportunity for an additional fee. (If the business opportunity is purchased, the database will flag the client as Referral Rep. and treat the Client ID as the Referral Rep ID) All of the information above will be written to the database and sent to the appropriate referral rep in email... Customer ID = Referral Rep ID This is my first time here... I hope everything is clear.. Thanks! gg