231941 Application Admin Needed

I have a website [login to view URL] which cost $300 to build but its incomplete with the application going to another site via java script cloaking, I need to have a small application form admin built, one that takes the information entered into the website and adds it to admin and emails that there is a new lead to me, it will also need excel download ability and use mysql. It needs to verify information for accuracy so it will not send if not completed. If you notice, the application is on many pages to try and capture the lead [login to view URL] [login to view URL] [login to view URL] and many more.. I will then add the code you give me and plug into all pages... Remember, the application changes questions based on your selection.. This is a must, I have to know what kind of lead it is... It will take someone who knows php no time to complete.. It would be nice if I were able to add and remove question in the admin depending on the type of loan needed.