Create a form with multiple radio button choices to put in Wordpress template

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Bids
17
Avg Bid (USD)
N/A
Project Budget (USD)
$30 - $250

Project Description:
I have downloaded a Wordpress template and am using it to create my website. I would like to create a form that has 4 groups of radio buttons, and depending on the choices from the four groups, when the person clicks the submit button, a URL will be sent. The first group of radio buttons has 3 choices (it says "Choose License" and the choices are single user, 5-user, 10-user), the second group of radio buttons has 2 choices (it says "Choose Type" and the choices are commercial, academic), the third group of radio buttons has 2 choices (it says "Choose Platform" and the choices are Windows, Macintosh) and the last group of radio buttons has 2 choices (it says "Choose Media" and the choices are physical CD, electronic download . After all the choices are made, the submit button is clicked and the appropriate URL is sent (I believe there are 24 URLs to pick from). This URL (which already exists) updates another website. This form needs to be placed inside a Wordpress page that I have created. This page was created inside a Wordpress template which I downloaded.

Skills required:
CSS, HTML, PHP, Wordpress
About the employer:
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