Diet Site with Contact Capture on 1st Page, CC on 2nd.

I need to create a site that is basically a landing page. The buyer is is directed to fill out a form with their name, address, phone and email in order to get a free trial product. On the second page (ssl enabled) the information from the 1st page is repopulated and additional information is entered: Credit Card info, Additional cost for shipping & handling. Shipping options would be regular and express. A check box that they accept our terms will be there to inform that this is a 14 Day trial only. At would be great to attach this to some type of CRM (customer management system). I don't know which can be used please suggest a good cart. Some CRMs come with code snipplets for the forms. (Most are very expensive maybe there is something we can costomize that is open source) The customers Credit Card will be charged using authorize.net. We can use the [login to view URL] API or if the cart has some integration. After the sale is complete it would be great to be able to up-sell a second item. Also an autoresponder should send a confirmation email with some advertisements. An example of this type of site can be found at mytoslim.com. You will be given a finished photoshop mock up of what we want. You will need to clean it up and recreate some design work. You will need to finish the artwork for page 1 and 2, Create a bottle design for our diet pill bottle. (samples will be given) Find a cart or CRM solution to handle customer purchases, upsells and auto responders. Install the site on our host. (we use hostgator) The domain has already been created and an SSL certificate from COMODO has already been installed.