lead form (wizard)

Need a lead capture form for a wordpress site. I will provide a clear sample to discuss further. The form will open up as a separate window and will ask basic questions about the visitor's mortgage scenario. After all necessary data is collected, the form will wait a few seconds then alert the visitor that several brokers can assist. Visitor will then be asked to input additional personal information to proceed. There won't be any formulas involved. We only need to capture visitor info. Should be relatively easy task.