Order Form

I need a programmer that can convert this jpg <[COLOR=#003366]image[/COLOR]> into a order form. When the radio button on the left is clicked it will display the price off to the right along with adding it to the total at the bottom. A shipping cost per item will be totaled also so for example base shipping cost of 10 dollars and for each category. Only one item per category can be selected. Except for the wheels category which will require 2 items to be selected. Also the contact information off to the left will need to be included in the form creation and the user must fill it out. Once the form is completed the user can either print it or email it. The following data needs to be sent via “method:post” <?xml:namespace prefix = o ns = “urn:schemas-microsoft-com:office:office” /><o:p></o:p>[/FONT][/COLOR]
[COLOR=black][FONT=Verdana]1. All contact information <o:p></o:p>[/FONT][/COLOR]
[COLOR=black][FONT=Verdana]2. Part number for items selected<o:p></o:p>[/FONT][/COLOR]
[COLOR=black][FONT=Verdana]3. Name of item selected <o:p></o:p>[/FONT][/COLOR]
[COLOR=black][FONT=Verdana]4. Price of item selected<o:p></o:p>[/FONT][/COLOR]
[COLOR=black][FONT=Verdana]5. Shipping cost<o:p></o:p>[/FONT][/COLOR]
[COLOR=black][FONT=Verdana]6. Tax if check box is selected<o:p></o:p>[/FONT][/COLOR]
[COLOR=black][FONT=Verdana]7. Grand total.<o:p></o:p>[/FONT][/COLOR]
[COLOR=black][FONT=Verdana]This data needs to be sent to both the user and my client via email. Also next to the Sales Tax area at the bottom there needs to be a check box or radio button so it can total tax for SD residence.

I also have the image in Adobe indesign.

Programming language doesn’t matter that much just needs to be error free and work in all browsers.

My client was just on the discovery channel Biker Build Off, credit will be retained by my company but you are more then welcome to add this project to your protfolio, as contracted.

If interested PM me.<o:p></o:p>[/FONT][/COLOR]