CUSTOMER INQUIRY AND RESPONSE MANAGEMENT WEB BASED APPLICATION

We are in need of a web based application that would use an existing excel database listing of our repair locations based on zip codes and an email address that corresponds to that zip code. Customer would visit our website and fill out a simple form with the following fields, Name, email address, phone number, phone model and fault description and zip code and upon entering the zip code the email inquiry (form) would be sent to the email closest to that zip code. This information would then be sent to a back end database that would collect the forms, date and time and the email address it was sent to.