Minor changes on a submit form

IN PROGRESS
Bids
24
Avg Bid (USD)
$32
Project Budget (USD)
$30 - $35

Project Description:
Right now, the form looks like:
http://www.integritydebtrelief.org/form/

We would like:
1) The top part of the form to have "Personal Loans" and "Student Loan Debt" removed
2) The bottom of form, instead of the slider, have check boxes, starting at $5k-$9,999 and then $10k-$19,999 and so on up to $100k and then $100k+
like you see on http://www.californiadebtrelief.org/Free-Savings-Estimate.html?fd-debt_amount=20000
3) When submitting from slider on home page to this form, the checkbox should be checked for most appropriate debt amount (e.g. if someone goes to page http://www.integritydebtrelief.org/form/?amount=50000 , the $50k debt range would be automatically checked
4) Change title to "Finish Getting Your FREE Confidential Savings Estimate"

Please confirm you can start today and finish today.

Thank you!

Skills required:
Graphic Design, HTML, PHP, Website Design
About the employer:
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