Capture Page (php most likely)

Hi Coders, I would like to create a 3 page capture page. I require the coding, I intend to do the design (design supplied, I can add it later but its so you can understand what I'm doing), but I need to be able to place the coding in sections so when I move it (code), around it is not broken. so if some stuff needs to be in a particular order, I will need to know that to. Page 1 Very simple, capture an email address and First name Please see link (I have attached to) [login to view URL] (Page 1) [login to view URL] (page 2) need to fix radio button) [login to view URL] (page 3 through to 9) Page 2 Is where we will quote someone by their first name and ask for more information Last name (surname) Email (where it is quoted from last page, so they can edit it if they need to) Phone Address City Country (We may take this line out or the form and add some other ) Some Radio buttons 6 options the last option will be an 'other' with a place for them to type a word or two. (this word or two will be used on page9) (some radio buttons may be removed) If they decide to leave, without completing the next stage I would like the first name and email address to be sent to one shopping cart (code will be supplied on sample page, as they have already opted in) Page 3-9 (based on selection will determine which of the pages they go to) I will need to create a page with some text (possibly lots of text) and place there first name and possibly their last name at where I choose. also depending on the page they land on 3 -9, so on the radio button page that uses the box for the visitor to put a word or two, that I can enter anywhere within the text to place that word on page 9 Oh and one last thing, would like an admin page so I can see which of the radio buttons is getting the most hits on, and how many are clicking on the first page, opting in, and completing the whole process, so I can test etc ## Deliverables Hi Coders , complete rundown, hope I have covered everything I would like to create a 3 page capture page. I require the coding, I intend to do the design (design supplied, I can add it later but its so you can understand what I'm doing), but I need to be able to place the coding in sections so when I move it (code), around it is not broken. so if some stuff needs to be in a particular order, I will need to know that to. Page 1 Very simple, capture an email address and First name Please see link (I have attached to) [login to view URL] (Page 1) [login to view URL] (page 2) need to fix radio button) [login to view URL] (page 3 through to 9) Notice the floating bar on the right where the registration is, this will be on all pages, though I don't care if you wish to rewrite in php etc, for your own way, this is just an example of how I want it to look (also as long as the float/scrolling table is a table, I can add the background images myself later to each table) Page 2 Is where we will quote someone by their first name and ask for more information Last name (surname) Email (where it is quoted from last page, so they can edit it if they need to) Phone Address City Country (We may take this line out or the form and add some other ) Some Radio buttons 6 options the last option will be an 'other' with a place for them to type a word or two. (this word or two will be used on page9) Radio button Option 1 (Page 3) Radio button Option 2 (Page 4) (will go to a different page) etc Radio button Option 6 (text box)(page 9) so depending on the radio page button, will determine the landing page they will be on page 3 through to 9 (some radio buttons may be removed) If they decide to leave, without completing the next stage I would like the first name and email address to be sent to one shopping cart (code will be supplied on sample page, as they have already opted in) Page 3-9 (based on selection will determine which of the pages they go to) (well actually 6 pages different pages in total, depending on radio buttons selection that they select, as mentioned above) I will need to create a page with some text (possibly lots of text) and place there first name and possibly their last name at where I choose. also depending on the page they land on 3 -9, so on the radio button page that uses the box for the visitor to put a word or two, I will need to have the code to place amongst the pages (pages 3 - 8, I can do manually) ie from the radio button, but on page 9 the text word they place will need to have a code that I can enter anywhere within the text to place that word on page 9 The only other thing nedd to note is this line <input name="defaultar" type="hidden" id="defaultar" value="392609"> The value for defaultar will be different for each of the final pages 3-9 It will be going into 6 different autoresponders based on their option from page 2 I have placed a template that I created/use and would like to have the same look and feel, I don't care if you rewrite it to suit your style etc but as long as it looks similar, with the registration scrolling etc. On page 2 ([login to view URL]) I have made an error with the radio buttons, but just to show an example, the O then text should be right next to it. Oh and one last thing, would like an admin page so I can see which of the radio buttons is getting the most hits on, and how many are clicking on the first page, opting in, and completing the whole process, so I can test etc I hope I have explained it well enough for all looking, please feel free to ask any questions. Regards,' ' Jason Liddell