synex

Hi is there someone who can help me with the following? I need a script within someone can subscribe to a website. It needs to fill in personal info (like name address and city), a option to fill in a second address, confirmation email and eventually a option to create a login to personal part (not necessary). I tried several scripts but nothing is really what I need. Can someone help me by showing where to start or has someone a simple script I can use? Kind regards, Rudolph