Help on progrmming Fax application please


I have set the following challenge for myself:

I want to create a program to fill in a form, step by step.
(Select: Business or Private, Fill in: Name, address, telephone, etc.)
This form has to be signed by the person filling in the form.
When complete, the form has to be faxed to my office and emailed to the person who filled in the form.

Can anybody please advice me on how to do this?
Or is somebody in the mood, for helping me with this?
I would like to program it myself, but I can use a mentor on this to start.

Can somebody assist me please?
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