Calculator Form

Hi,

I simply need a calculation form (or forms) which work like this one . . .

http://bit.ly/gNhuWU

. . . so it sends us the details, makes the calculations, and produces a similar final results 'page'.

I'll provide the age ranges and percentages necessary for the calculations.

I need the form(s) to look good too please; at least as good as the form(s) in the link above, but using colours which fit well with the following colors . . .

#c9c9c9

#8d3a32

#182a80

If you know a bit of jQuery or similar to fancy the form up a bit (and possibly have it contained on one page with a bit of animation), then that will be a definite winner in the bidding stakes, but it's the calculations which are the most important and the speed of delivery for the project too.

The forms need to be ok on mobile devices/browsers too.

Thanks :o)