Program creation, will earn $35

Hello,
I have this program that i need to be made and have the source code sent to me. This is what i want to happen..

-a vb program with just 3 textboxes and a button

-when the user enters the info in the boxes and clicks the button, the info gets sent to my server, which is displayed in a file as a .txt file, XML, php, html, file or whatever is easiest.

-A different log file is created for every different user who enters info.

That is all. I will pay $35 for this program, and if you are interested please post back or pm me so we can talk further. Thank you!

-Calvin August