Web Based Data Entry Form

I need a web based data entry form developed from a Microsoft Access form for an existing mysql database. We are currently using Microsoft Access to view / edit our existing mysql database. I would like to convert one of our existing forms from MS Access to a web-based form. I can provide a copy of the MS Access database and form. You will need to be able to build the web form and model it after our MS Access form. This form already has the format we want including the main form, the sub forms, the queries, database structure, default data items, hidden data items, etc. The database currently has no web based forms so an initial setup will need to be created such as an admin page to manage users and user rights to the new form. All code and rights will be provided to me for future use and development of our site. I would require any information required so you or another developer could edit / update your work. Tables to be used in the form (actual table names are different, just listing descriptive name here): Main Tables: clients table tickets table address table contacts table vendors table accounting table equipment table Actual number & name of tables is viewable in the MS Access Database. Rough web form need: The data entry person will need to be able to do the following: Select a Client Company Name from a drop down list (which pulls from our Clients Table) Enter the Clients Ticket Number Select the repair type from a drop down list Enter the ticket location information: - Enter the address of the ticket - Enter the zip code which will then pull from our zip code table to automatically enter the city and state Select the vendor id from a drop down list linked to our vendors table Select the vendor profile (will default to vendor selected above but allow for edits from a drop down list) Select the Timeframe Type for the Ticket from a drop down list Enter the service date and have the pay period date auto entered based on our pay period table and the related service date Enter the end date of the ticket (we use this if the ticket spans multiple days) Date received (this field will default to current date but allow edits in the event data entry is behind) Enter the time we are required to start the ticket and the time we are required to finish the ticket Show a field at the end of the data entry which allows the data entry clerk to copy and paste to create calendar events and will pull information from the above fields to show: Client Company Name, Ticket Number, Timeframe Type, and Repair Type Show another field at the end of data entry that allows for copy/paste of the location information. An option button to allow more detailed data entry for advanced tickets to include: Item code Rate Amount Rate Type Fees Description End User Name Site Company Name In the background, there will be the following items: Date entered (enters actual date of data entry) Internal ticket number (auto counting field from our tickets table) Ticket status (defaults to active) Client ID (auto entered based on the client name selected by the data entry clerk)(pulled from our clients table) Followup By: default field to indicate the next person responsible for the ticket Followup Required: default to new ticket status Your bid should be a flat rate amount to develop this form to completion. I have tried to list all relative items to make your bid easier but I cannot guarantee that I have listed all fields, tables, drop-down lists, etc. I can provide a copy of our Microsoft Access database for reference and all login information for the mysql database.