Adfly URL shortener

Adfly URL shortener

I've received been playing with Adfly, and I've hooked up my own domain,
and I want to have it hosting shortened URLs.
I wish to create a website that you type in a URL (google{dot}com) and
it'd automatically add this to the suffix of URL of the API code, so it'd
turn
hxxp://api.adf.ly/api.php?key={KEY}&uid={ID}&advert_type=int&domain=adf.ly&url=
to:
hxxp://api.adf.ly/api.php?key={KEY}&uid={ID}&advert_type=int&domain=adf.ly&url=google.com
I'd really love it using HTML or PHP
I'd also really like if it was on the same page, not going to a new page.
Nothing too fancy, but this is what I'd hope it'd look like. this Then
it'd change it too: this
~
Thanks in advance.