Complete a simple form, create database

I have a form, that I have started to make, it is located here? <[login to view URL]~coverall/[login to view URL]>.? The form needs to be completed, the output of the form need to be stored in a database, which you will have to create, and the form needs to be accessible by customers at a later time.? need one page - [login to view URL] to be completed and made so if the client is already registered, his info will display in the form [login to view URL] form? also needs to? be validated by security image to make sure it is being submitted by humans, not robots. need one? page to? list the name of everyone who filled the form and another page? -? so I can access the information and change it at will. need database created where to store the info. Don't have a big budget...