Create online form which updates MySQL database and sends confirmation emails

Create an online form based off a current word document form, with everything being fillable online, with radio buttons for Y/N etc, and drop-down boxes where applicable. The form must be easy to use and visually good looking. On form completion by user, form will add values to a MySQL database. DB must be created by you, but all the Column IDs will be provided by me to use in the DB formation and implementation. On form completion by user, form will send an email confirmation to the customer, and also an email confirmation to the business owner with a copy of the completed form included. I will include a template of the email the customer will receive. Format the application being sent to the business owner in the email in a pleasing, easy to read manner.