Moderator Apply (Php i think :P)

[Lockheed]

Hello Mc-market users,
i am a owner of a minecraft network 150 daily players
i want to talk a step forward =)
i want a moderator apply website i got hosting i want a few questions and a space so they answer and when they submit thier answers be sent to my email thats it ill talk more in skype
Skype: live:salman965kuwait
NOTE: My budget is 10$

 

[Lethal]

wat

 

[Maccas]

wat

He wants a web page where his players can send in a staff application with a given format.