Affiliate Tracking Lead Widget

I need a simple widget designed that my affiliates can plug into their websites. This code will then operate as a widget/mini form. It will simply say first name and email optional. Once their info is entered they will hit submit and be taken to a different website or page (to be determined). This page will have another form that once filled out will send an email to both the affiliate and me and a third party that someone has filled out the form. The third party email is optional. I may not have that pre-set. This will require a simple dashboard that allows me to track the activity from each affiliate site. I would also in phase 2 like to be able to pay each affiliate via paypal for successful deals arising out of the lead provided. So maybe a paypal .xls export easily uploadable would work?? I will have the artwork provided - you will simply have to get it working right. ## Deliverables I'll provide the form fields I need to have on each of the 2 forms. 1) the mini little form/box installed on page 1 of affiliates site 2) The larger form gathering data on the secured page, on my site/server. I don;t think I'll allow affiliates to have their own page. ALSO, when someone clicks submit on the first page which asks only their name, it will preferably auto populate the name field on the second page that opens automatically.