Contact Form with PHP

1. “Company Name”-text input <1> 2. “Your Name”-text input <2> fields first and last Name, “Your Email”-test input, “Your Phone number” 3. “I <2> am” - multiple choice of <3a>“an employee of or” <3b>"a third party company hired by” <1> if <3a> then "Your Posistion at-<1>-text input <4a> if <3b>. then "What is the name of your company”-text input <4b> 5. “Are you the owner of <1> or <4b>”-Yes or No if no then “Who is the owner of <1> or <4b> “Name”-text input first and last name, “Position at <4b> or <1>”-text input “Email”-text input-this email must be different from 2., “Phone number”-text input- this phone number must be different from the phone number on 2. 7. “Are you authorized to purchase products or services on behalf of <4b> or <1>”-yes or no if yes then “Do you require approval before making a purchase for <4b> or <1>?”-yes or no If yes then “Who do you require approval from?” “Name”-text input first and last name, “Position at <4b> or <1>”-text input “Email”-text input-this email must be different from 2., “Phone number”-text input- this phone number must be different from the phone number on 2. On the email fields we do not want to allow for @gmail, @yahoo, @hotmail, @ymail, @rocketmail or any other free email client etc. If they try to submit with one of these email clients have a tool tip or error message “Please use a secure email client for communications such as a business email address” preventing them from submitting the form. The form can only be submitted if all of the fields are accurately filled out. At the end of the form we need a check box for “I agree” & a small text display box that contains a terms of use text, it can have that has a scroll bar if needed. A query signature box “Please Sign” I have this code if you need. Submit button button only after all of the the questions are correctly answered, the “I Agree” box checked & the signature box signed. After submitting the PHP script need to redirect to a Thank you page- we can build this if needed We then need to have a confirmation email sent to all of the email address inputed into the questionnaire the message reads “ Thanks you for contacting The App People, please verify the information below and reply back with the best date & time to be contacted” then list all of the questions with the answers filled out, Then list all of the users identifying information such as date, time, Ip Address, path way, computer os, etc, then the “I Agree” followed by the terms in the box, last the signature in the signature box. You can use this Signature plugin for that: [login to view URL] Let me know how much you want for this? I need to make it done asap!