Customized Web Contact Form

We are a "web 2.0 financial tech company" looking for something like a contact form where people are asked certain questions about their finances (i.e. "How much bonds do you own"). This contact form should be standalone (meaning NOT integrated into our existing website) can be simply uploaded onto our servers and given a certain address to work (i.e.: [login to view URL]) A few requirements of the "contact form": - Has to be fully functional as a full-page contact form (all filled-out fields (data) are e-mailed to an e-mail address we want) - Aesthetic web 2.0 look (simple "modern" looking web2.0 form with slight gradient. A loose and crude idea of the look would be: [login to view URL] - but it has to be a lot more complex than that - Multi-page and multi-tab functionality (sections) where the user can shift through differrent "pages" of the contact form by clicking next and back or by clicking the tab for the section. However, ALL the data throughout the pages must be sent in one e-mail when the user submits at the end. - Somewhat of a specific design (colors and certain gradient are already in mind)