PHP Email Form that can select recipients based on date input

The project requires building a generic PHP email form that can forward an enquiry to different email addresses based on the value input into one of the fields.

Specifically the form needs the following...

1. Input field - name validation (letters)

2. Input field - phone number validation

3. Input field - email validation

4. Drop down field - validation - must make a selection

5. Input field which controls the action of the form based on number entered.

This needs to remove the UK Pound symbol if entered and forward emails to different recipients based on the value entered. For example:

< 100 to email address 1, 100 to 150 to email address 2 and >150 to email address 3

This field needs validation - numbers only

6. Validation Message should be at the end of the form

7. Form to be able to send autoresponse email to sender from the specified website domain name.

8. Form to send contents of email in a simple but well presented email to single email address with From field displaying email address of sender for instant reply.

9. Code must be easily editable for tailoring to exact requirements. Code should not viewable by web users.

10. Styling of the form is not required - we will take care of this.

11. Standards compliant HTML required. Must work in Firefox 2-4, Chrome, IE6-9, Safari. No Flash.

Optional
Depending on cost - data to be stored for periodic export to MS Excel

Many thanks