Web Database Needed Fast!

We need a small web app built to do the following: We need to track information submitted from a form on our website. 1) User enters data and submits information from our form 2) Admin Panel - Admin needs to be able to view the contents of the page and update status (comments/chkboxes, etc (all fields)) 3) Sub-Admin needs to be able to login and update status (comments/chkboxes, etc (some fields)) 4) User needs to be able to track these submittals via a code or someway to specify their submissions (view only) This all needs to be web-based. Needs to have reporting functionality. Report per user, per code, etc. Once form is submitted, need to have information stored in database and emailed in a nice format. This must be compatible with [login to view URL] web server. We will require user-friendly instructions to install and use. If you have a similar system that we can demo, please let us know asap. This needs to be completed within 5 days. Thanks, Jim