Dear Concern,
I have gone through your requirements and seen the HTML page. But my question is .. do you want to save the into databse using PHP? please make me clear I can do it what ever you want.
I'm a senior web app developer for more than 5 years with expertise in all latest web technologies. I have an expertise in PHP, JAVASCRIPT, JQUERY,AJAX, MYSQL, JOOMLA, WORDPRESS.
I believe in quality work with minimum charges and I'm looking forward to hear from you.
Thanks & Regards
Nafiz