Convert MS Word form to pretty AJAXified HTML form.

Hi, I need a long MS Word document (an insurance application form) converted to an html form, using AJAX (JQuery) form validation, type ahead input boxes (where appropriate) and calendar date selection widgets. We are trying to make it as easy as possible for our customers to enter this form. The Word document has about 200-300 input fields. The document is separated into 5 lettered parts, please make 5 separate html files that correspond to each of the parts in the document. Each form field should be unique so it's easy to integrate with our backend application. We are looking to build something like this form application at the link below. [login to view URL];risk=veh In your application, please include examples of similar work. I will retain the ownership of the completed forms. Thanks!