didn't get you idea quite well , but this is a looong story

you can use the form action in the page you want to submit your info to ..
like :
and in this page.php make an IF statment to see if the fields were fell down or show the error message ,, a basic example of what you need:
you can format the output using the simple HTML <b> , <u> , <i> and <font> to format your output ..