Make exact php form as on the given examle

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Bids
11
Avg Bid (USD)
$57
Project Budget (USD)
$30 - $250

Project Description:
I am building a site and i would need a form on my site made identical as one on the link www.estera-ulaganja.hr/on-line_prijava.html . I would send you an html template of the site and you would have to make the same php form like on the site from the link. In the form, after all the blank fields would be entered and a button "posalji" which means "send" clicked all the information should go to a presetup e-mail.

Skills required:
PHP, Software Architecture
About the employer:
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