90045 Flash Banner

Basically I need a flash banner that should be around 300 x 300 pixels in size that does the following. It should have a form field when loaded that prompts the user to enter his birthday and a field that asks for his email that I want stored in a database or file. Also on the intial page page I want a couple external links. Then after this info is correct and the user hits submit the next "page" is an external graphic with a link embeded in the flash that shows for a fixed time period. Then after that the next page based on the birthday shows information called from a database or file. Usually I do not take out Flash projects so if there is something in here not possible please let me know. I can start right away on this. Please note I have really detailed info on this but with time contraints I do not have much time after the intial explanation so please bid accordingly.