Buying need a complex form in php/html

hi

i need someone to code me a script in php/html.
an example can be found here:
psd-slice.com/order.php
make sure you follow all steps and play with it.
the form should email me the results
payment by paypal...please pm with price and time to deliver it

 

i have sent you PM, please check it out and let me know, delivery in next 3-4 hours