Build a form using HTML and PHP

Here is a simple scope of work I have prepared for the project titled "[login to view URL] Transportation Contract" IF YOU CAN NOT WORK ON THIS IMMEDIATELY DO NOT WASTE MY TIME OR YOURS. I NEED IT DONE WITHIN 24 HOURS. The purpose of this project is to replace an integral form the client uses to bind their customers to a contract for transporting various livestock which is mostly horses. This form represents the agreement between the 2 parties for the services Triple-AC-Ranch will be providing. An existing form is already in production and needs to be replaced immediately. Here is that form: [login to view URL] Here are the requirements of this project: Rebuild the form in html and PHP so that it can be integrated in to a Wordpress template page. (we will handle integration) The new form should look as much as possible like the existing form at the link above The form should include the same required fields as the sample above and use any form of user friendly validation possible, preferably CSS that references the exact field that doesn't validate upon submission. The form will need to write to a MYSQL database which is already in production. Creating the supporting table(s) to store this data is part of this scope. The form submission data will need to be sent to multiple email addresses in a friendly format. An autoreply must be sent to the person submitting the form using the email address supplied in the form. The autoreply must include all language in the contract and the form data as this is the customers copy of the this contract. ** Be sure any dollar figures submitted with the form validate as numbers or money as there are future plans for the use of this data and it must be correctly structured If it would expedite development I can supply the html of the existing form. Let me know of any questions or additonal requirements in order to supply an estimate and completion date/time.