->Fast $10 if someone can tell me what software can create this web form - URGENT!!

Thanks, but these won't work. They either have monthly fees or require html/css.

 

Any luck so far JB? I am curious how this turns out. I would like to be able to do the same thing you are in need of some time in the future..

 

Still no luck finding something that does it all.

There's a few solutions that will design a pretty form,
but it either has a monthly fee or you have to design the
form yourself in html/css or it has no payment processor.

So far it looks like I'm going to have to create the form using
a form script that accepts pp integration and then I'll have to
pay someone who knows html/css for the layout to make it look
nice and clean like the example I gave in the OP.

I've actually considered trying to learn a little html/css and do
it myself, but I think that will take me away from what I do
best which is sales, marketing and business management.

Thanks for all your support. Still open to suggestions.