bulletin board videoes

Hi, I need to extend the attached script as follows: When a user hits a video button I want it to pop up a form like the attached. Upon submission the script will take the input from the vidurl field and strip out the following data (indicated by XXXXXXX)dependent on which video site they select: Youtube: [login to view URL] Vimeo: [login to view URL] Liveleak: [login to view URL] Veoh: [login to view URL] Daily Motion: [login to view URL] College Humor: [login to view URL] Whatever string the XXXXXXX represent will entered on the page as a tag in the folllowing format: [video="input from vidsites dropdown menu"]XXXXXXXX[/video] I hope that all makes sesnse. Jez