Replying to Anybody know some basic programming and want to make 75 bucks

I need a basic executable program has a reasonable looking visual interface with 10 input fields and saves the input to a spreadsheet

2 of these fields should be for password and password confirmation (should display as stars and must match to continue), and a couple of boolean fields plus one drop down menu.

Who ever can make something like this for me gets paypaled 25 dollars. If you can add a layer of control so that in the program, after entering an admin password (doesn't need to be change able), i can edit the title of the fields, change the output destination, and change the background image, I'll paypal you 75 bucks.

Also can write an official letter of recommendation on company letterhead if you want to send it to schools or your mom or whatever.


PM if interested.