capture input data and FTP to a site

I need a very simple ASP.net page that prompts a user to input their cell phone number (validates it by inserting dashes on form as it is being input. example: xxx-xxx-xxxx It then should drop the dashes when the number is saved. The form should also capture the first name. When these two fields are accepted from the user they are sent via FTP in a CSV format example (xxxxxxxxxx,firstname) The FTP site I want it to be sent to should be configured via a config file that that accepts either an ip address or site name, user name and password for FTP site). Once the submit button is sent the site needs to redirect the user to a success page. That page should have sample text that I can modify. Example "Your data has been submitted" This site needs to be written for a mobile device. Very simple, very readable on an inphone or android