650 Simple Mortgage Application

The website is [login to view URL] I want a simple Mortgage Application form. I expect the winning bidder to go out and find all the most common fields other similar sites require and make up a form. The form will collect the field data on a series of pages so the visitor is not presented with the whole form at once. I want a post function to msql. A completed application will generate an email to the website owner who will go to the site in secure mode and use a password to access the form data. Use HTML or PHP, I dont care. I need an immediate turn around time. If I select you then I expect this done in a day. I will leave great feedback too. Thanks and good luck.