can someone make me...

[chosting.biz]

I really need someone to make me a full script in PHP, CGI, or Perl (these are the languages my server supports) so people can automaticaly get an account? These are the fields I want that people need to fillout:

Full Name:
Age:
Username wanted:
Password Wanted:
E-Mail:
Recommended By:

Please type the following sentence exactily as it looks: (as a anti-spam field)
I want free webhosting from www.chosting.biz. I also agree to the t&C of www.chosting.biz.