Create simple entry form that goes into MySQL Databse and integrates with email

Entry form needed that can be dumped right into a MySQL databased that is hosted on my server (for back up purposes) and then have the capability to export this to excel spreadsheet if needed later on. Also when? a form is submitted, I'd like the capability once a form was submitted to have the data submitted to a designated email addresses.? The data that needs to be collected First name Last Name Email Phone with area code Secondary Phone: Fax Company name Mailing Address - text box City State Zip Country Site/url/pgae to be promoted keyword to be associated with site description/purpose/objective of article - (Hint, what do you want your article to be written about) Buttons: Submit Clear submit and Start Another Entry form for my Next Keyword This should be fast and simple for someone who knows what they are doing. Simple html. Nothing fancy. Do it by tonight.