Create custom facebook page tab

Hi, I would like to create a very simple custom Facebook page tab that appears as the first page when someone loads up the Facebook page. It should contain first: - a block of text (which I will provide), then - a simple form: 3 fields entitled: "Phone number", "Email", "Your resort", then - Submit button, then - a small block of text (which I will provide) We should have a simple way of collecting the info submitted from the form. Just an automatic email generated with this info would be fine - or saved to a database - whatever is simplest / cheapest. We should be able to know the person's Facebook profile who has submitted the information on the form. Let me know your thoughts in private message, looking to get this done quite quickly. Thanks!