Creating a sample form (insert / edit / delete) as per specs mentioned

Dear Freelancer, I need to transfer the attached sample form into an operational form (php/mysql/ajax). Select Box 1 reads from a table (call it select_box_1) and should contain a primary key (tid) and a varchar 255 (name) Select Box 2 reads from a table (call it select_box_2) and should contain a primary key (tid) and a varchar 255 (name) Select Box 3 reads from a table (call it select_box_3) and should contain a primary key (tid) and a varchar 255 (name) You should create a table to save the contents of the form The uploaded documents should be stored into a folder called (uploads) and the file names should be renamed into a 10 digit random number I need this form to be done for (insert / edit / delete) the forms should be validated and submitted using ajax (no page refresh) and a loader has to be shown were appropriate. Please read carefully the information in the "Yellow PostIt" in the PDF file. Thank you.