Simple Order form for web host.

I’m about to launch a new project, I have designed and coded the site in html/css however I need someone to code the order page for me.
The order page is already coded and designed in xhtml/css, however I need either it coded so the user can fill in details, add certain extras on the order form and the results are sent to me by email. So I need someone who can code in PHP/.NET

The customer has a few different options to pay monthly or yearly, or add a few extras, so the price on the last page can be changed depending on what the customer selects, and then payment is processed with Paypal, so the order form must be coded to link to PayPal and setup a recurring payment for the customer.

I need this done as soon as possible.

I can provide you a preview of the order form, so you can get a better understanding of what needs coding.

There is no admin or client section, or CMS to adjust products, so it’s quite simple to code
There are only four packages to choose from.

Thanks
Chris