Greetings Chris,
Mike from Toronto, Canada here!
I've read yoru specification outline and would love to get this running for you.
The credit card information when submitted will send you an e-mail notification (NO CREDIT CARD INFORMATION SHOULD BE STORED on an e-mail).
The notification then will link you to a secure administration panel, that'll require your login credentials (You can decide) to display the form contents.
How's that sound?
All the best,
mike