Application With Ability To Download Leads After Applying

Hello, Please read this in detail. In a nutshell, what I'm looking for is the ability for me to create an application for visitors to fill out on my website. My system works so that only 'qualified' people would get called that filled out the application. I would want for you to create a section on my website that I would login to in order to do 2 things. 1. Create an application and afterwards getting the code to place anywhere I wish. Sort of like the application you see here. [login to view URL] 2. Download only 'qualified' leads as an excel file with the date range that I specify. The system will automatically filter our unqualified leads by checking what they have put in the section that asks 'How Much Do They Have To Invest'. So by the time I login, specify the date range that I want to download, the system would only provide me with people that have money to invest. The excel file thats able to be downloaded should contain this as well. So for example I would be able to login to something like: [login to view URL] Inside, I can create an application to place on my website with a simple template like the image link shown above. It would generate me a code to do so after I create the application. I would also be able to specify a date range for me to download leads that have filled out the application and had money to invest. You would program it in a way so that for the field that asks 'How Much Would You Have To Invest In Your Internet Marketing Career' it would automatically disapprove applicants that selected 'none' Lastly, the application should have a captcha to catch spam and the ability for me to choose the redirect url after filling it out.