Nice looking Flash email form

I have a request for an actionscript developer (AS2 or3) to create an interactive email form in flash. It is basically a combination of a few text fields, radio buttons, checkboxes (in a scrollable pane) and a free text field. The last part of the form (where a user puts in name/phone/email) appears after a horizontal scroll. The email parser can be created in PHP or ASP (.net)
The design is created in photoshop.
The site needs to go live on the 26th of November, so the form needs to be tried and tested before then.