Hi,
I went through your project description. I can do it within the specified time.
I am an experienced developer having 8+ years experience. I work on php, HTML, css, JavaScript, MySQL, WordPress, WooCommerce, OpenCart etc.
I'm ready build online application form for your site. I'll consider all the points you've provided.
I assure you that your site will be fully compatible to all the devices.
Looking forward to working with you.
Thanks,
Mascot India