Need website form to collect data and place in MySql

This project was successfully completed by hossaincse2 for $15 USD in a day.

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Project Budget
$10 - $30 USD
Completed In
1 day
Total Bids
Project Description

I have a simple landing page online and would like for the form to:

Collect Name user enters

Collect Username and check that is available by indication.

Collect email address and check that it is not already resisted.

Add DOB and check check they are 18 or older.

Collect Ip address

collect timestamp

All goes into database with a simple back-end for me to manage and sort data.

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