Change HTML Form

I need a number of simple changes made to an existing form. I can process the form myself its just a layout issue as i need some of the drop downs and checkboxes changed to radio buttons. I need the form to layout in a similar manner to what it is now but adjusted to fit the new fields and layouts. If you would prefer to build from scratch but keep the general look and feel thats ok Please see attached html and excel doc describing the fields that need to be added or changed. May also need to add one additional field ## Deliverables 1) Complete and fully-functional working program(s) in executable form as well as complete source code of all work done. 2) Deliverables must be in ready-to-run condition, as follows (depending on the nature of the deliverables): a) For web sites or other server-side deliverables intended to only ever exist in one place in the Buyer's environment--Deliverables must be installed by the Seller in ready-to-run condition in the Buyer's environment. b) For all others including desktop software or software the buyer intends to distribute: A software installation package that will install the software in ready-to-run condition on the platform(s) specified in this bid request. 3) All deliverables will be considered "work made for hire" under U.S. Copyright law. Buyer will receive exclusive and complete copyrights to all work purchased. (No GPL, GNU, 3rd party components, etc. unless all copyright ramifications are explained AND AGREED TO by the buyer on the site per the coder's Seller Legal Agreement). ## Platform cross browser compatible