Custom Flash Form

I currently have a html/php for that submits to email. I need this same form in flash. There is javascript in the form that controls the hours that can be selected by the user based on the day of week. This code can be source viewed here: [login to view URL] I will send a sample .fla for you to see the formatting needed. If you are able to integrate the included DateChooser that would be ideal, if not just let me know when you bid. If you can do this in one day, I am interested.