Build Responsive Order Form With Total Price

Hello! I need Responsive Order Form for my new web site. I'm building my web site. If you can build me a order form for that please contact me. Here are the requirements. When someone fills and send the order form; 1. It should send emails both of me and the customer with TOTAL Price, AND UNIQUE ORDER ID. 2. It must contain some security, like captcha. 3. Should be responsive and clean. 4. E mails should go to the inbox, NOT to the Spam. 5. Immediate completion is must, (within 2-4 days) 6. Validation. Things I will provide you; 1. Packages with prices. 2. OLD working example form (old web site link) ________________________ Customer comes to the order form page > Select the Trip Type (1. One way Trip / 2. Round Trip / 3 Excursion Trip) > Select Arrival Location from the drop down list > Select Destination Location > Select Pickup Date > Select Pickup Time > Fill Flight No. > Select Number of Passengers > Name > Email > Telephone > Comments > Captcha > SEND > Thank you message with ID and TOTAL. ________________________ Thanks..!!