A Credit Card Submission Form

Hi, I want a coder to create a simple form like this one that we are currently using-- [login to view URL] Except, in addition to submitting the credit card and address info, I want to hook it into our credit card gateway processor (PsiGate) and have it pre-authorize a certain amount on the card, that I can set easily in the code that runs the form. The form also needs to have all the standard features that auto-detect if a bad CC is entered, and provides valid error messages, etc. A simple database should be setup to hold the submitted information, if our machform database is not able to do the job. This is a simple project. Overview: - Web form with the proper fields - Proper error msgs, etc. - For admin: - Ability to select if the form will activate a "sale" or a "pre-authorization" - Ability to select the dollar amount that will be charged - Ability to select the currency, since we charge through our CC processor in US funds and Canadian funds. - Need to be able to store, edit and delete submissions in a simple SQL db. - Need to be able to easily customize the header and footer info for the form.