Integrated Call back form

General information for the website: Find A Debt Advisor
Kind of development: Customization of existing website
Description of requirements/features: Hi,

I would like a wordpress expert to add an Integrated Call back form to my website www.brightdayfinance.ie and the form needs to automatically send me an email when someone completes the form.

My wordpress customized theme needs to stay the same and the call back form plugin needs to be removed and it's a pop up screen and too much info is required on the form.

I would like a form like the one on this website - http://www.nationaldebtsolutions.co.uk/

I would like the income and debt amounts and number of creditors options to be added too as the person can move it along to pick the amount that applies to them.

I look forward to your quotes.

thanks
Rory
Extra services needed: Installation, Customization
Extra notes: