Build a Website GUI using EXTJS

Need a two page EXTJS application. Just need the Front End using EXTJS. Following are the fields: Page 1: Step 1: Personal Information • Title Mr • First Name XYZ • Middle • Last Name ZYZ • Birth Date Step 2: Contact Information • Address • City • Country • Postal Code • Phone • Email Step 3: Store Information • Routing Number: 435709 • Account Number: 38926869 • Account Name: • VAT Number: 3890758457 • Custom10 direct Step 4: Select a distributor (ID) ID# 001000000001 (call a webservice to display following information • KOKO MAUGHAN • ELGIN, IL • • Email • Phone CAPATCHA Button to submit Page one Page 2: Display information entered on first page Step 5: Select Product 3 Products Option Box (values will come from web service) For now hard code Product 1, Product 2, Product 3 (based on selection display information below, values will come from a web service) • New Distributor Pack • Description: Takes the new Distributor directly to Assistant Supervisor level, so they can, in future, purchase at wholesale price. This pack is a great way to try the products and introduce the products to potential new Customers. Contents: Contents may vary. • Item Code#: 080 • ShipMethod: Free • Total: 199.75 GBP Product Shipping Options • Ship • Pick up • Ship to Other Address • Address: 30 Portman Sq • City: London • Postal Code: W1H 7BH • Country:: GBR Error validating address * Address 1 * City * Country * Postal Code Re-enter Address Check Address • Address 1: 30 portman sq • City: London • Postal Code: W1H 7BH • Country: GBR • Re-enter Address Delivery Instructions (Text box free field) Payment Info Card Number: CVC: Expiration (MM/YYYY): / Button to submit (web service will be called to validate data)