Simple Website Banner, Database and Case-Tracking Widget

I require a website widget that can easily be added to an estate-agent’s website (perhaps in the form of a simple banner), and which requests a name and either a contact phone-number or email address from the client clicking on it (which is stored as a unique user profile) and then leads them through to the following mortgage search page on my website - [login to view URL]~p1mort/search.htm. The data that they input on this search page and the result of their search using this facility then also needs to be stored (perhaps even just as a screen-grab?). This stored user-profile and user search info must then be available to be incorporated into a case-tracking system (please see the attached screenshot for how this should vaguely look), should they eventually progress with a property purchase. The majority of the information to feature in the case-tracking system can be manually input. In essence this project requires two simple databases – one with stored client information and one that can be updated and accessed in real-time (the tracking system). PLEASE PLEASE PLEASE don’t bid on this unless you are absolutely sure you can deliver what is essentially quite a simple project – I’ve already posted this twice before and had winning bidders drop out shortly after beginning the task.