PHP Order Form + JQuery

I am in need of a order form built with jquery &php. I had previously posted this and selected someone to do the work, but unfortunately as is the case, they didnt know what they were doing, said they could deliver in one day and then i got nothing. So here I am again. If you you can do this then MAKE SURE YOU PAY ATTENTION TO WHAT I NEED BELOW: I am looking for a form exactly like this: [login to view URL] I like how the form updates with a price when they choose the number of pages. I would like to have the same amount of days 1 through 10. Default day on the slider should be set to 1. Id like the same functionality their form has where it shows the price depending on the pages a user picks, and underneath it will say the same things they have in the form. You can add any dollar value to the days as I will change these after the form is done and delivered. Fields for the form are: 1. Name (required) 2. e-mail (required) 3. Project name (required) 4. Phone 5. Additional Project Information 6. Address me as Sporshok in your PM so I know you have read this far. 7. Field to insert download link or upload file. 8. Captcha Field using google captcha or something similar, if you have something that works, you can use it 9. section above the submit button where some text can be inserted, kind of like a terms section with a check field that they must check in order to submit. THE SUBMIT BUTTON SHOULD NOT BE CLICKABLE UNTIL THEY CHECK THIS BOX 10. After clicking the submit button the user needs to be redirect to 2checkout page for the payment and when the payment completed the user should be redirect back to my site with a confirmation message. In the meantime the user should receive an email about the order has been made and the site owner should receive an email that an order has been placed with details. 11. If you can implement this features as a wordpress plugin, it will be very exciting. CSS should be easy to change and everything needs to be commented. I am not interested in your ability to design web sites. i am looking for experience in building good quality, functioning forms, so if you have examples of forms you have created please show me. If you are chosen, I want to see a demo of a fully functioning form. I will send you the email address where all of the information is to be sent when someone clicks on submit. if you are chosen you must be available via chat, such as skype, google talk as i use these extensively. AND PLEASE FOR THE LOVE OF GOD SPEAK DECENT ENGLISH AT LEAST.