add a shop

The program would allow users to add there favorite shop, or whatever into a mysql database and be able to see what others have added. Kind of like a guestbook but viewed by state or provance or country the required fields would be, the users name the shop name the shop address the shop phone number a small text box for directions a textbox for comments about the shop. The program would idealy give the user the option of adding several shops to a printable list. Also the program would send e-mail thanking the user for the submission and sending e-mail to the admin. I would like the proggy to be written in php. the server is a linux box running apache 1.3.19 mysql version 3.22.32 and php4.0.5 as a module Thanks ## Deliverables I would like to see the program run on a production server with all error reporting on. ## Deadline information No Rush, Somtime before the end of June