PHP Freelancer Available

I'm an experienced PHP programmer looking for some work. I charge relatively low and prices can be negociated.

I also sell simplePHP usersystem's at $5 a piece and do custom usersystems with whatever you'd like. You can PM me for a quote.

I have a very short term project and would appreciate a bid.

Please take a look at this website - http://www.pestthreat.orkin.com/drtv/index.aspx?cm_mmc=national-_-pta-60-_-DTV000-_-_&utm_source=national&utm_content=pta-60&utm_medium=drtv&utm_campaign=DTV000

I need a webpage very similar to this example. I have 5 pages for the form and 1 page for contact info. The form pages have assignable values for the questions which total once the user has provided contact information.

This information is then emailed to a programmable email address.

I need the webpage developed along with the form functionality. Can you please let me know what you would charge for this project?

Thanks in advance for your assistance.