200345 PHP Write script

Please see the attached php file. It is an exmaple of what needs to be done. nothing fancy. Our moderators will input the the value in the radio box Yes or a NO, and a URL link in the other box. Need the script to take all info from this page, and write a dat file or txt file to our server. Then by calling on the variables need to create a html page that list the current status of the files. Need this done ASAP, so pleae only bid if you can start working on it immediately. Regards,