Write some Software

I need a simple software that have some fields in it. and when submitted sends me an email of those field. shouldnt be more work for one expert. full spec: menu: file - work entries - exit workpane: fields: -> Port (text field) -> ID (text field) -> URL (Link field - the URL friend) -> Counter (Integer field) -> Type (Dropdown - two option) -> Button (submit) -> when the submit button is pressed, validate form: 1. if the ID and port are corresponding (if id == 122735 && port == 2787). 2. if url is valid. 3. When type is #1 the counter should be less than 10000 and if type is #2 counter is less than 9000. if form is validated: 1. the information should be sent to my email. 2. the entry is added to be displayed in work entries if you can do this, pls bid. cheapest bidder will win. this isnt' much of work. thanks