Wordpress: website for web quote

Avg Bid (USD)
Project Budget (USD)
$30 - $250

Project Description:
Need someone to build a insurance quoting website. This website will be custom to retrieve data input from a customer so we can call them back and give a live phone quote. Need to have a plug in to make sure the phone number and email is not a fake.

The web page will retrieve address,age, sex, birthdate, phone number,zipcode,email, height, weight.

Final landing page:www.ehealthinsurance.com <----CPA

http://www.netquote.com <--quote site (example)

Please dont bid if your price is over $50

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