Create a 1 page form

Looking to make a 1 page form with 1 drop down menu + 4 columns of check boxes. The form simply adds new values to the URL before submitting. Check the attached image, this is how I want it to look. The main question (the "what gift should i get") would be the category in the url: [login to view URL] The check boxes would act as tags: [login to view URL],column2value,column3value,column4value I know how to do this, it can be done via simple HTML, but i want it cool looking with some error responses when a certain column is not filled. The attached image is pretty much how i want it to look like, simple, with the same font... maybe a tad bigger but not much because this will be embedded in a overlay popup. Extra space on top so I have room to play with (logos, adding a search bar ETC). Instead of checkboxes maybe have the 4 columns highlight on click? IDK. I want something simple yet web 2.0. Can ya do it? If so, how much? :D