542538 PHP Contact Form

Hi there, 1. I require a php scripted contact form for a personal website. 2. It should conform to the style of the attached .jpg file (i.e. text box borders 2-3px #000000 (black); font: Helvetica , also in #000000 (black) etc. Basically, the live form should look as close as possible to the attached image. 3. All fields to be mandatory. The dropdown menu for 'subject' will have four list items. 4. Input data to be emailed to a provided email address when user clicks 'submit' and correct answer to the anti-spam question. 5. I'm not a webdev guy, so I will need instructions on integrating the script code into the html contact page, and the form .css into my existing stylesheet for the site. I can provide ftp credentials but ideally i'm looking for someone who can walk me through what I'm putting where. I will select a bid based on communication capability rather than price. 6. I am willing to spend $150 for someone who can help me get this up and working. 7. Please do not send me links to general portfolios. If you are going to send me your work, only send links to specific, live contact forms styled similarly to the one required. To save everyone's time, I will disregard anyone sending a generic pitch. 8. Please do not bid if you don't feel that you will be able to replicate the look of the form as shown in the attached image. 9. Thanks in advance.