296121 Simple PHP/MySQL Project

I need a simple PHP/MySQL application written that will handle remove requests for my mailing lists. When the user clicks a link in their email, it takes them to this page where they provide their email address and submit it. It will show them a "thank-you" page, and insert their info into the database. If their email address is already in the database, it will check to see how long ago their address was inserted into the database. If it was more than 72 hours, it will ask them for the name of the site that sent them the email advertisement, and send an email to me with the name of that site, and the user's email address. ----- Site owners should be able to go to a different page which will allow them to access the list of emails that have been inserted into the remove list. They should be able to get a list by date, date range, and just a complete listing. If you can do this within the next 2 hours and you have a reasonable bid, I will accept it. thanks