16114 PHP DB Script

I have a simple script that I want to be able to track my activity with. I want to be able to enter information with mostly a copy and paste in a field that will show what I have. Here is a link for you to go to and see exactly what is needed. However, it doesn't have to look exactly like this, if you have a better design, let's see it, but this is pretty much what I need. Details are on the page for you to read. [login to view URL] If you have any questions, don't hesitate to as me. I would like for this to be completed ASAP, but I am working on a very limited budget. I'm just trying to keep track of information that I already have in order to task it.