Create a form to quote connected to SQL db

I need a freelancer that can build this form quickly. In a couple of days. Make sure you read the attachment carefully. A calculation part is already done. The form needs to go directly to a part where the customer get's a quotation that can be altered. Also it needs to generate an email as long as they didn't decide if they will go ahead with this or not. The back end needs to keep the information of the customer and give us stats about which customer came on the site and where they clicked. See attachment for further details. We will not do any down payment, we will create a milestone and release when job is completely finished. This all needs to be integrated in our MySQL db and in our wordpress page. Again freelancers read carefully and the price you bid is the price you need to build it.