61721 Need script form for website

Hi, I need to make a pre-qualification form where people will fill out information, submit it (information will to a specific email address) and after clicking submit, they'll get a " thank you page " and then be redirected to an specific website. I can provide the thank you page if needed. for the pre-qulification form I have a sample and I want to use the "exact same fields". please pm me if you need more details, but thats pretty much what it is. Thanks! here am attaching a sample of the form I want. I want to use same colors.