Contact Form & Database MySQL

Hi, We have finished our website design written in HTML & CSS. We need a contact form with the following details below; 1. After the submission of the form, all info will be stored in database. (If the form page can be multiple pages that would be perfect) 2. On a different page a visitor types just the date and the name then the rest of the information previously stored on the database comes up. 3. Allow them to change the information on the database after a certain amount of payment made via paypal. 4. Print the new information and save it into the database.