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need a little script to input a form data into whmcs ticket

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i want to use a form to collect some data and input those data into whmcs ticket,


can you help me write the script?



a) user need to login whmcs first before he can read the form page.



b) the form page may have two main part,people will write their data into items01~items05


part 1

-- items01


part 2

-- items02

-- items03

-- items04

-- items05



c) when people click the submit button,


this form script will help the submitter create a new ticket in whmcs,


and put the data of "items01" into the subject of the ticket,


and put other data of "items02~items05" into the message of the ticket,



hope you can understand what do i mean,


if you can help me write the script or you are interested with it,


please feel free to pm me with:


1. how long you can finish it

2. how much would you charge

3. your work or your profile.




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