Create a cutom poll / survey

Can you create a custom survey / poll ?

Please see the attached document. After the user votes, the results need to be instantly displayed in three columns with the users comments attached. The poll needs to be put on a [url removed, login to view] website, so you will I will need the code. I have tried most things like Polldaddy, Wufoo Forms, Survey Monkey, Formstack etc they do not work for what I need. I will award the contract to the person who gives the best solution and shows that they understand what is required.

Thank you for your time.

HTML HTML5 MySQL Diseño de sitios web

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