Re: Php form module
You mention PHP in your question. I wouldn't use that for a job like this, preferring compiled code.
Having said that, here's some thoughts.
1) I wouldn't look for existing code. I'd write this from scratch. It's not a huge job and you'd end up with something you understand, that meets your standards and that you can easily maintain. Somebody elses code is, in my experience, often a disaster and actually takes more of your time than just doing it right.
2) If you're not an experienced programmer, I'd find one to do the job and make sure it's nicely documented and ensure that you can maintain it indefinitely.
3) This sounds important. I'd make sure that hosting is solid. You don't necessarily need an SLA (Service Level Agreement) but the service should be professional (which is not that common with the consumer grade ISP's, unfortunately).
4) Your specification would benefit from more detail, nailing down exactly what you want.
5) Depending on your programming framework and the exact specification this might be all doable with "glue level" programming, which reduces the programming burden.