Web page form submitting update

Hello, I need someone to tidy up a form page on my website, the page is: http://www.perfectturf.co.uk/quote_supply.shtml

The main change is to add a field where the person filling in the form can upload a picture, and title it "If you think it might help, please upload a photo of the area (not required):"

Another change required would be to simply make the form look tidier and more like other contact forms, eg separate lines for each address line, perhaps select county from a drop box, split post code entry into two boxes, instead of the word 'required' use a star symbol

And i'd also like to add a picture to the page to 'pretty it up' a bit!

I hope this all makes sense, if there's any other details you need please ask. I'd be grateful if you could let me know how quickly you can carry out this work, and a total price please.

Many thanks, Jon