Web based program that outputs graph based on user input

I'm basically looking for a script that I can add to Wordpress page that asks the user a few questions and then outputs a graph showing the results. Attached is an example of something made in excel to give you a very rough idea of what I'm after - but this needs to work within the browser (a little like this page too [login to view URL]) Here's what it needs to do... 1 - Ask user to input some data (around 4-5 fields) 2 - Calculate results (like in the excel spreadsheet) 3 - Output results in text form as well as create a graph 4 - Overlay a second part to the graph such (for example: current profits vs projected profits) 5 - Ask users for their email once the questions are computer (reveal the email box only at the end) It needs to work in all majors browsers on both Mac and Windows. I'm not 100% sure how this can be done so let me know if you have any questions or suggestions. I'm willing to spend under $100 to get this done.