Build an 'Request a quote' form for my transportation website.

Looking to build an online quote request form for a bus hire company. The form would need to take as much info as possible about a given excursion so that we could provide the customer with an accurate quote. The form would need to take in data such as: * Date of the excursion * Company requesting the quote (Company billing address, phone, contact person, email address, ABN etc) * Is it a single trip or a multi trip excursion? * Point of origin - address, time for pickup * Point of destination - address --> if multi trip excursion, allow for the entry of multiple 'legs' of the trip * Number of passengers (students / adults) * Special notes / requirements * Contact person for the excursion (name, mobile number) Further thoughts: We'd need to store each quote request in a MySQL db as well as email the request data (html formatted) to our admin email address for follow up. As an 'extra', could we generate a google map once the origin and destination addresses are entered showing the estimated trip route, number of kilometres and the estimated time for the journey? We could actually auto populate the 'arrive at destination' field I look forward to hearing from anyone interested.