PHP Registration Page to database

This is a $30 project. I need to create a simple PHP page as follows: DATABASE: Create a new table on our database named CROSSWORDPROB PAGE 1: [login to view URL] See attached file for layout. • Logo at top • 0.5px horizontal rule @ 100% • Text: ALL TEXT IS ARIAL SIZE 10 We are sorry for the problems you've encountered with The Times Crossword Club. Please fill in your details below if you'd like us to send you a copy of XXXXXX as a small token of compensation for the problems you've experienced. Your information will not be added to our database, or anyone else's. * Denotes a mandatory field: • Table with blue background #E8F3FD • In table, 7 entry fields. 4 of these are mandatory. • 3 Buttons at the bottom "Submit, Reset, Cancel" RESET: this button will clear all of the fields CANCEL: This button will take you to [login to view URL] SUBMIT: This button will check for errors • If there are errors then the following message: "Please fill in ALL mandatory fields marked with a *" • if no errors, then all fields will write to individual columns in the table CROSSWORDPROB that you have created on our database. Then the user is taken to page 2 where there is a message under the same logo and horizontal rule "Thank you. You have successfully submitted your details. You should expect to receive your book within 28 days. Please now click here to go to the home page or simply close this window." • click here will take them to [login to view URL] IMAGE FILES: See attached the header file. You can use standard grey buttons for the SUBMIT / CANCEL / RESET. TIMING: Need this doing now and completed within a few hours.