Amend an existing website application form

We need a web-developer that will amend a website application form that I have. The link to this application form is [login to view URL] Two changes needed please; 1) Under the question in the form that reads: “Please confirm which finance or law firm you are currently employed at *” Currently, there is a tick box next to each firm listed. The change I want is to have all the firms listed in two drop down menus.; one drop down menu for “Finance” and the other for “Law firms”. The user must select one (and only one) firm from EITHER of these two lists. VERY IMPORTANT: When a firm is selected, the firm name and email address is automatically listed in the question below which reads: Please confirm your work email address. This will only be used to verify your employment at (NAME OF FIRM SELECTED FROM PREVIOUS QUESTION). We will not send you any promotional material to this email * In addition, right under this question is a blank text box, which must be populated, and right next to this text box is the email address of the firm that automatically appears when a firm is selected from the previous question. These features must not be changed when you amend this form. 2) I want a secure admin area (with a username and password that I can change) that allows me to edit /add/remove firms that are on the list of finance and law firms. In addition I want to edit the email addresses of the firms that I add/edit in this list. E.g. The admin area would allow me to edit/remove/add to the firms and email address rows. Finance firms Email address Bank of America @[login to view URL] Barclays Capital @[login to view URL] Citigroup @[login to view URL] Law firms Email address Allen & Overy @[login to view URL] Ashurst @[login to view URL] Clifford Chance @[login to view URL] Please note: When someone completes this form I receive an automatic email with the answers. This feature in addition to all the other features of this form must not be changed. I only want the additions to this form shown above. VERY IMPORTANT: To separate you from the spammers, please write LLAMAS as the first line of your bid. We will delete all bids that do not start with this word, since most bidders never read the requirements. Thank you for being one who does.