Cell phone unlocking API integration page

Hi. I have a GSM Unlocking website already built in php. Currently is was the "stock template" im looking to make it my own and clean it up a bit. Also i need to integrate an API into a PHP page which I will then host on my own servers. Basically, I want my customers to be able to submit their phone's IMEI number (15 digit serial number), their phone model, provider, email address, and country which will then be transferred to the company's unlocking calculator server. I will give the winner my individual API key. I only want a basic page with a form, and a confirmation page as well as confirmation emails sent to both me and the customer. I have a few sample website to reference from. Thanks!