Basic Script Required

Need a very basis script creating urgently. Needs to be done immediately. I need a form making. It just needs to say - Name and Paypal address. When the user presses GO it should post the details to a database and take the user to this example link: [login to view URL]%%PAYPAL%% Where it says %%PAYPAL%% the paypal address tht was written in the form box should be added to the link when the user presses submit. Chris Manager