Convert Excel Quote sheet into web form and DB

We're looking for someone that can take an excel sheet we use (to provide clients with quotes on their Web project) and convert it into a web form that people can use to request web development quotes from us. I've attached the excel file to this project so you can take a look. The idea is to have an online form where people can request a quote from us, but it also tallies up totals so they can get an accurate quote depending on the services they choose. We will need 100% exclusive rights to this and you can't use it for your own purposes and you cannot sell it afterward. The person chosen for this project may get additional work from us (we are a very busy firm) in the future. The data should dump into a MySQL database, but if its too expensive to do that we might consider a simple email form.