549125 simple calculating script and mailform

I am looking for something simple but essential. I am looking for a coder who can create a form that allows the visitor to get a direct quote when he or she wants to exchange e-money for cash you can find an example here : [login to view URL] But i need it to look much better on my website The exchange rate on my website should depend on the amount of money that needs to be exchanged After succesfull submission of the form the visitor should receive an email ( styled html ) concerning his transaction request and instructions. I will be happy discuss the possibilities. Happy bidding !