ADSL and Phone application

We provide ADSL & Telephone service and i want an application form to be designed as soon as possible please as i need to pass it on to some customers. The application will contain: - company name with logo & address - fields to include customer details (phone, address, date of birth, etc.. all the generic stuff - fields to show the plans & prices and the customer should be able to tick the plan that he wants I can show the coder the forms that we have at the moment and i dont mind if you copy the same one but modify it to contain the details. The file needs to be in word document and pdf format. ## Deliverables 1) Complete and fully-functional working program(s) in executable form as well as complete source code of all work done. 2) Deliverables must be in ready-to-run condition, as follows (depending on the nature of the deliverables): a) For web sites or other server-side deliverables intended to only ever exist in one place in the Buyer's environment--Deliverables must be installed by the Seller in ready-to-run condition in the Buyer's environment. b) For all others including desktop software or software the buyer intends to distribute: A software installation package that will install the software in ready-to-run condition on the platform(s) specified in this bid request. 3) All deliverables will be considered "work made for hire" under U.S. Copyright law. Buyer will receive exclusive and complete copyrights to all work purchased. (No GPL, GNU, 3rd party components, etc. unless all copyright ramifications are explained AND AGREED TO by the buyer on the site per the coder's Seller Legal Agreement). ## Platform word document and pdf