simple email address database

I need a simple MySQL database to store email addresses. Nothing fancy, it should just store the email address, the date it was added to the list and the ip address of the remote system that added it. I also need a no-frills html/php form for adding email addresses to the db. It should just have a single field to accept email addresses, "submit" button, and upon submission say "your email address has been added". I also need a password protected page for displaying the email addresses listed, one per line. I am also in a bit of a rush, so this needs to be done quickly. This is html/php/mysql on a BAMP server (bsd, apache, mysql, php). ## Deliverables 1) Complete and fully-functional working program(s) in executable form as well as complete source code of all work done. 2) Deliverables must be in ready-to-run condition, as follows (depending on the nature of the deliverables): a) For web sites or other server-side deliverables intended to only ever exist in one place in the Buyer's environment--Deliverables must be installed by the Seller in ready-to-run condition in the Buyer's environment. b) For all others including desktop software or software the buyer intends to distribute: A software installation package that will install the software in ready-to-run condition on the platform(s) specified in this bid request. 3) All deliverables will be considered "work made for hire" under U.S. Copyright law. Buyer will receive exclusive and complete copyrights to all work purchased. (No GPL, GNU, 3rd party components, etc. unless all copyright ramifications are explained AND AGREED TO by the buyer on the site per the coder's Seller Legal Agreement). ## Platform freebsd, apache, mysql, php