Streamlined Sign-Up Form Indonesia

I want to add a small “Alamat” sign-up panel to my site so new visitors can register quickly and cleanly. At minimum I need a responsive HTML/CSS form that plugs into my existing page layout and stores submissions in a simple database (MySQL is fine). I’m expecting typical fields—name, email, and address details—but I’m open to your recommendations if there’s a better way to structure it. Basic front-end validation for the email field is essential; anything more sophisticated (phone or custom rules) can be optional and quoted separately.

Please build and deliver:
• A styled, mobile-friendly form component
• Server-side code to capture and store the data securely
• A brief README showing where to drop the files and how to test the submission flow

Once I can submit a sample entry, see it land in the database, and receive a confirmation message on screen, I’ll be able to sign off on the milestone.