form data entry site with payment gateway

site required with 15 dynamic pages *****only users with excellent ratings need apply project needs to be completed within 14 days (not too complex site) hide keywords (mootools or something similar) form based site that collates and sorts data and sends via email at set times to set users email autoresponder with link to extend user time for site use payment gateway video/image upload function logo design short 5-10 second flash/jquery link several urls using 401 redirect some help links on a few pages I have diagrams to explain it better. ****must be live by Feb 19, Site is very limited with graphics, mainly text via forms etc code to manually enter for real user authentication back end statistics to see how many users and from where etc. / timer count down visible on back end ip tracking on all users text editor for me to update text and some training too for me (i have some coding skills -html ) set up my email to outlook & mac pc