Build a simple web page that calls a web service

I need a web page that will call a web service, the web page will have two fields and two buttons... field 1 is a dollar amount like 125.00 (must have decimal) and field 2 is a four digit code like 1234 (must have four digits only). Button 1 is START OVER, this clears out anything input in fields 1 or 2, Button 2 is SUBMIT, when submit is clicked, it takes the data from fields 1 and 2 and puts them into a web service (I have the web service completed) and then calls the web service (or consumes it), the web service will return a 1 or a 2, and then you will display an image (1.jpeg or 2.jpeg) you can display this on the same web page or another web page, your choice.