Design and development of 2 Forms in existing website.

Industry: Business
Kind of design: Single web page
Num. of web pages: 2
Description of every page: I need 2 forms ready in my website and linked with respective buttons. I need both, design and development. The form's design reference is attached please have a look, I want this in blue color but design should be same or better than the attached file. When someone fill the form 2 mails should be send 1 to me consisting form details and 1 to respective user consisting Thank you message and confirmation. Once user will confirm his mail then another mail should come to me in same box.

This is all I want..
Ideas for the visual style: shared in attachment
Things to avoid: Anything that can lower down the speed..
Website url: webexplorerz.com
Extra notes: No immature and time wasters please... My budget is fix $40 - Around 3000 Rs. (Attachments will be available to selected candidates)