66834 Php Form Creation

We need a form created. frontend: PHP backend: mySQL Fields: Name (prepopulated drop down list) Date (autopopulated) Numeric 1 Numeric 2 Numeric 3 Numeric 4 Reporting: Daily Average per name (past 30 days) Monthly Average per name (past 12 months) Graphing: Daily (past 30 days - 30 plot points with each days numbers) Monthly Average (past 12 months - 12 plot points with each months average) Each plot point would show the number that it represents. For each graphing we would have a graph for each numeric value (total of 4) and the names would each have thier own color code with plot points and numeric values with each plot point.