Autofill program for website

Need an autofill program made. A website I use requires a Firstname, an email address, same email address a second time, a java box checked, and a 13 digit number filled in. It then emails a link to the email supplied. I dont have any webhosting, so I think a program that runs on the computer is best. I can supply lists, txt files I suppose, of say 1 per line, first names, email address's, and then 13 digit numbers. The program you make would pull data from the txt files, or you suggest what can be done here. I'm guessing its java, I'm not sure. The url to the site is in the attached .zip file. You check the "extra care" box, and a field opens below to accept the 13 digit number. It either accepts your info, and says thank you, and emails you, or it error's out, by saying the email addy is alredy on file, or that the 13 digit number is invalid. Looking for a quick turnaround on this. Thanks for looking.