Website submission form and mailer

I need an email submission form for my website that asks for various fields (such as name, email, 2nd email, 3rd email, message). Once submitted, the details should be saved into the database. Create a simple admin panel ([login to view URL]) protected by a .htaccess password. From here, I should be able to see the queue of submissions. Display each submission in rows with columns named 'Name', 'Date/Time Submitted', 'Email', '2nd Email, '3rd Email', 'Message'. At the end of the row have 2 buttons, the first called 'Approve' and the second called 'Delete'. 'Delete' will delete the submission. If I click 'Approve', an email must be sent FROM the '2rd email' TO the '3rd email' they provided. These emails are not hosted on our mail server so must be sent like 'Spoof' emails (similar to [login to view URL]). I will set an email message. That submission should then be moved to a new page called 'Sent' (eg [login to view URL]). Thanks Lowest bids will win. Please PM me for more details