I need a php signup form created for our website. The form will need to be submitted to a MySQL database securely because of the credit card information. The database will need to be accessed via the web securely.

The signup will need to be a three steps (page) process.

PAGE ONE: WEBSITE USER SIGNUP PAGE

ACCOUNT INFORMATION

First Name:
Last Name:
Email Address:
Password:
Confirm Password:

PAGE 2: SELECT BACKUP PLAN

Personal – 10GB - $10/month
Professional – 25GB – $25/month
Small Business – 50GB - $50/month
Enterprise – 100GB - $100/month


BILLING INFO

Credit Card Information

Credit Card Type:
Credit Card Number:
Security Code: What's this?
Expiration Date:

Billing Address

Name on Card:
Street Address:
City:
State/Province:
Postal Code:
Country:
Phone Number:

PAGE 3: CONFIRM AND SUBMIT ORDER