Write some Software

Hello to everyone i need one survey page like this on attachment. We need to have one survey/vote page . We have some group artists (Best Male Artist, Best Female Artist, Group, x , x, x, x) We need every visitor can vote up to 1-2 artist from each category , But we need to restrict this voting , every computer can vote one time each day,for exaple one ip per day can vode After submiting the vote the one popup come and say "Thank you" Results: I do not want the results can see it anyone, i need to has the ability to see only me... for example , an back-end page wich show the results e.x. Best Male Artist 1 , Votes 200 Best Female Artist 1 , Votes 189 Best X Artist 1 , Votes 160 Best X2 Artist 1 , Votes 120 Best X3 Artist 1 , Votes 100 Best X4 Artist 1 , Votes 20 if anyone has a question please contact me and i answer as soon as possible... i will attach it how i need to look. Please keep in mind that i want to have the option to change the name of category or artist of each category. I need to have the option to change everything from the form. At the end of the survey/poll i need the voter can write the name, phone and email . those details i need it some how to get it.