Custom Calculation Script for Website

I require a Return On Investment (ROI) script created for a website, it can be in a separate HTML page as I will display in a modal window.

Any language accepted, would be nice if the fields updated automatically as the client inputs figures.

The end user will input 2 figures and the script would return multiple calculations based on the input and stored values, the output will look like a paragraph of text with figures embedded.

Finally the script should request an email address to send the results to the client, this will include some additional info (header etc.).

Timeframe for the project is a few days.

I have the desired format of the output and an example spreadsheet, please ask for a copy.