Design and implement a PDF form to interface with SQL

This project is to design an adobe pdf form that pulls some information from a SQL database, allows the user to input some information, then saves the form data to a SQL database. This has to be done remotely, so I will provide you with a connection to our test database. You will provide me with the finished form and any code (well documented) that was used to make it work. I must be able to change the code because this will be deployed for a client on a different SQL server and make adjustments to the form as needed on a quarterly or yearly basis. In your bid, please tell me what experience you have in this area, what technology (languages, etc) you will be using, etc. I do not have a sample of the form to load, but it is very plan with 12 total fields. Name - user inputs Email - user inputs Date - autofil todays date Item 1 - Category - drop down list of options pulled from SQL database (about 6 options here). Item - drop down list of option pulled from SQL database - based on category selected Description - autofil from sql database on Item selected QTY - user input Price - autofill from SQL database on item selected Line Total - calculate from Qty * Price Item 2 - same fields from above repeated . . . . Item 3 - same fields from above repeated . . . . Order Subtotal - add up both lines Notes - short paragraph entry by user. Submit . . . save all of the data to sql table, display message confirming order was saved. NOTE: They may expand to more line items so please make this flexible!