online order form

Hi I have a simple form i need, for some reason i cannot do it myself on google docs.. it is just a client that wants to be able to order online with me, I need to create a specific simple order for for them. It needs to have a couple of key options input the date input the purchase order number select the item (there 3 mens items in two colour options, 1 unisex item in one colour option and 4 ladies item otpions 2 of which only come in one colour and two which have two colour options) then select sizes and qty they will order multiple sizes and probably more than one style per order then an order confirmation should be sent to them and email to me with the list of what they have ordered. My website online ordering system is a bit complicated for this client they are a bit older If possible I would like to put their logo and my logo on the form and even at the bottom images of the various styles iwth the codes so that they know could you do this, how much do you think? How long? cheers Soraya