Apply Online Credit Application

I have a website developed in CS3,. but i need to oursource this part of the site.? The form (which i have hardcopies, its two pages) needs to be able to be pasted right on my page which is already made.? The program/form would accept user input such as: name - date of birth - social security number - current address. actually quite a bit of information, i will list all later but obviously because of the sensitivity of the data "SSN" this project needs to securly compile this data in an organised fassion and display it for our office workers to view, also im not sure how this information would be stored, some type of database i imagine,. im open to options from people with experiance with this

## Deliverables

Just need someone with experiance that can turn this project around very quickly

PHP

Project ID: #3449910

About the project