Convert a Template to a Website

Looking for someone who can basically copy the quote request form found on [login to view URL] It needs all the same functionality and links to city/state/zip and car year/make/model databases. I don't know how to keep up with this kind of stuff so the databases need to be mainintained by a 3rd party (possibly Google Geosearch API or [login to view URL]). I'd like it to be multi-step to keep it's size the same as autotransport411. I use a tracking software that my current quote form is linked up to ([login to view URL]). My current form is just their code plugged into a quote page. I was told by jtracker that I can create my own form and just add it to their list of lead producers. Also, my new website is being built by [login to view URL] and they'll need to be able to plug it into the homepage and whatever other page I may choose. Thank You, James Taylor