Custom script that can submit and pull data from an external website

Ends 21 Mar 2018 (in 3 months)

I am not sure if this is possible so am putting this out there to see if anyone can do this with either javascript ajax or xml
I need someone that can create a script that can submit data to the webpage:
To prepoulate the name and address fields, submit the data and either return an error response if information does not match or if succesful it will need to enter an email address and submit the form again
Once the name and address information is entered correctly it asks for an email address once this is entered correctly then sends an email to the users account.
I will need to be able to add a button or link to my website that will submit the name and address and email, I then need this script to send through either a confirmed message if the details were submitted correctly or an error message if not.
As i said not sure if this is at all possible, but will be a nice challenge for someone who likes this kind of thing :)

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