Yes I would like to work on that project for you.
I have a few questions:
1. uploading scripts to your server
2. access to your server
3. Can you find out if "magic quotes are enabled" on your server?
4. php and mysql available on server
5. Will info collected from the form be sent to email address or database?
more later.
thanks
Rod Russell
rod.webpagesofease@yahoo.com