Simple Payment form that uses Authorize.net

I need a simple PHP payment form that uses [login to view URL] SIM - How this needs to look and function: Users will click on an image such as "Make a Payment" They will then need to fill out a form that asks the following information: First Name, Last Name, Company, Address, City, State, Zip Code, Phone, Fax, Email, Invoice Number (If Applicable), Payment Amount When the user submits the form, it needs to take them to a verification page to verify the information before they process the payment, they should have a link that allows them to edit the payment amount. Once they verify the information they will need to click on a "Process Payment" button that processes everything through [login to view URL] (API Login ID and Transaction Key will need to be able to be hardcoded into the PHP file or as a secondary PHP file. An admin screen to edit that would be nice but not required.) The payment should process and the user should get a confirmation email that can be modified by another web designer.