Php Tool- Small Job

"We would like a script to allow clients to sign up & pay for ad slots on an ad grid. You must program a 2 stage form that will take the following details: Stage 1: Email First Name Last Name Length of Ad Placement - 1 month ($10), 6 months ($55), 1 year ($100) File (accepting an image, resizing to 16px x16px) Stage 2: Payment details The payment must be taken via [login to view URL] (integration guide [login to view URL] PMN_integration_guide. pdf). It would be preferable to use the Quicksale method that utilises CURL. Please remember to post the email address so that the customer can receive the receipt. At the end of this process, if payment goes well, The customer should be rewarded with a success message and an entry should be made into The "adbox " table. Please create the adbox table yourself with whatever fields you deem necessary for generation of the box."