Recreate Website with Quote Form

I am looking for someone who can create a page we currently have on one website and include a quote request form. The web page you design MUST look identical to the one we currently have. Within this page, their needs to be a quote request contact form This quote form will need to 1. Once a customer submits their information, they get an e-mail saying we received their request. We will provide exact wording for you to in put. 2. We need to receive an e-mail to our e-mail address with the details of their order. 1. Full Name, Phone Number, Email Address, Selected Delivery Method with zipcode and city/state, Event date, Event type/Event Details. Order details that include Quantity, Size (we will provided sizes), item description, Color. THis e-mail will need to be formated in a way that when it is e-mailed to us it is easy to read. The form will consist of drop down menus, option buttons and a date clandar. You can view our current website to give you an idea of what the page you design needs to look like. DO NOT and I repeast DO NOT bid on this job if you are unable to COMPLETE THE JOB BY THE DEADLINE or DESIGN A PAGE THAT LOOKS LIKE THIS LINK!!!! [login to view URL]