Code PHP and HTML landing page to pass data to database

I need someone to take an existing image and convert to html then make the form validate and pass the data into an existing mysql database. When you pm and bid please type in "window" so i know you read this. The mysql db already exists and the art work is all done this is just a code job one page with 2 minor variations (example on one page I ask for name and email and on another I ask for name, email, OR phone). Also there will be one small change in the database. So you need to be proficient in html, php, and mysql. Also I am very particular with the work and validation, just so you know... Thank you, Steve.