Create Joomla Module based on bookingcom request form

The project is to create a module from an existing form that send a request to the booking website. Also a date selection with a calendar is required. Back end: - Field to put in affiliate ID (hidden field name="aid") - Field to put in region (hidden field name="region") - Field to put in language (hidden field name="lang") Front end: - Arrival date selection field (standard value = current date), with date selection calendar. - Departure date selection field (depature date needs to automatically adjust to the after de arrival date, when arrival date is selected) , with date selection calendar. - Select box if no dates are set (see example picture) - Submit button (image) In general: - Needs to look modern (Ajax style) - CSS guided layout - W3C xhtml correct - Javascript(s) in separate file - From needs to be able to work when Javascript is turned off. (manual date selection) Atached pictures [login to view URL] is what it looks like now, a working script that needs some comversion.