Customer order form

I need a page that allows my customers to fill in order information and be able to be sent to the right paying page and charged the right amount of money for the product/service selected also the order details need to be sent via e-mail and added to a database ## Deliverables Stage 1) Customer selects product/service from the website, customer gets directed to page. Stage 2) Page displays a title of the product/service the customer selected Stage 3) Customer fills in form that contains: 1. Full Name 2. E-mail 3. Contact Number 4. Address 1 5. Address 2 6. Town 7. County 8. Country 9. Post Code 10. iPod Serial Number 11. Computer operating system 1. Windows 2. Mac <!-- --> 1. Windows 2. Mac 12. Message 13. Payment type Stage 4) Information from the form and the product/service the customer selected is sent via e-mail to <order@[login to view URL]> and submitted to a database, the customer is then directed to the page depending what payment method they selected and the price of the product/service. **Example** ** ** Customer selects to have their iPod Nano 3rd generation screen replaced. The page displays this at the top above the form. Customer fills in the form selecting to pay via Paypal. Form details and iPod Nano 3rd generation screen replacement are sent via e-mail to <order@[login to view URL]> and added to a database Customer is re-directed to the Paypal site to pay the amount of the screen replacement.