Fill web form, get results, export to excel

I need a simple executable (dont care in what language) that will open a url, fill 4 blank spaces in the web form there (4 string values from columns of an xlsx file) and write 5 values back to the same xlsx (in 5 other columns). Screenshots provided to the freelancer who takes it over as well as clarifications if needed. Rational offers only or else I'm doing it on my own and I dont have any time for it :)