442137 Customer Call Tracking PHP/MySQL Script

I need a php script with a backend db MySQL The purpose of the script is to be able to take all phone call messages and enter the information while we talk to the customer. As right now we are using a word template to manually enter all incoming call info. I want this script to be able to accomplish the data entry very easy with predefine option so we make it easy to work with the info while we speak to the customer. Fields: 1. Name 2. Last Name 3. Phone 4. Address 5. Access Code 4. Email Project Type: (Options) 1. Inquire about Screen Enclosure 2. Inquire about Screen Patio 3. Inquire about Insulated Roof 3. A Only roof 3. B With Screen 4. Calling about Aluminum Roof 4. A Only roof 4. B With Screen 5. Inquire about Car Port 6. Inquire Aluminum Railings 7. Inquire Purchase Materials 7. Inquire Custom project Once any the option above is selected the following info is required Dimensions: 1. Length ______ 2. Width ______ 3. High _______ 4. Color 5. N/A Footing Predefine: 1. 8"x8" Screen Enclosure 2. 16" x 18" Aluminum Roof 3. N/A Permit: 1. Yes 2. No Setup Appointment 1. Yes 2. No Follow up with customer 1. Next Day 2. One Week 3. Don't do Follow up If Yes 1. Month 2. Date 3. Time 4. Year 2010 predefine (this option only will change one a year) Customer Seems Interested 1. Yes 2. Maybe 3. No Comments or instructions box We place comments or additional info if required Requirements 1. I should be able to add this customer info to the db. 2. I should be able to retrieve customer info very easy 3. I should be able to print customer info very easy 4. Back end db should have an option where I can customize fields. 5. This is a web application so I should be able to login and get customer info from any computer. Need Nice Layout