Petition help., help with petition setup. (will pay) Options

[smiles247]

Hi guys. I've been meaning to learn HTML for a while now, and now that I have a project, I need someone to guide me. If anyone can walk me through the whole deal, I'll be sure to compensate through paypal.

Basically what I need to do is to create a working petition. This includes 5 inputs.

1. First name
2. Last name
3. Email Address
4. Drop box state list
5. Zip code
6. Description input box

The filled out information should be sent to some sort of database or file, saving all the submissions somewhat neatly (as above without the numbers). The inputs should require the user to fill them all out. Description box should be filled with a default sentence. One submission per email.

Each submission adds to the "number of submissions" bar, which will grow over time until the bar reaches full, which will be the submission goal.

Everything else I can workout on my own. It's a simple petition layout for the most part.

If any of you have had experience with something like this and have found another way to host a petition on your website, as in a free customizable petition template or such, that would help me also.

thanks guys