Competition Entry Page

Hi, I need a copy of this page here: [login to view URL] The page has to submit the details entered into a mysql database using php. The design needs to be flexible so I can change the background color, and image at the top easily in the future. ## Deliverables Hi, I need a page like this. [login to view URL] When somebody has filled in their details I need it do a postcode search (have signed up for a service here [login to view URL]) that can be used. The final details then need to be submitted to be added to a mysql database on my server. I would like the second page to have 5 offers which are yes/no (see attached jpeg). When you click submit on this page, I would like thee yes or no answers to be submitted to the mysql database. Deliverable wise would like this up and running on my hosting, and would like any original files. Thanks, Tom