Sample dBase Web based. 
Please give it a try. Also this page can be behind a login and password home page.
First Name  Last Name 
   
Address 1  Address 2
   
City  State Zip
     
Email  Web Address
   
Phone  Lead Type 
   
Other Lead   
   

Submit  Cancel

This form is the front end of an Access dBase.  You could either download the file and manipulate it or I could create a web query tied to a Page (click here) or this could simply be a Access desktop application.  The only advantage to the web front end, of course, is that you would only need to have Access on one machine and you would have the flexability of doing data input from any machine that has internet.