Data Input Form to go on website

We require a data input form to be designed, which can be placed within a website. The data input into the form? will then be emailed to a specified email address and also compiled in a database. The form will ask the following questions, some of which will require text to be input and others will require a drop down menu: Title Full name Email Phone number Suitable time at which we can contact you, if so required? (Daytime, Evening, Weekends, Anytime) Address of the property to be sold County Post code Age of property (years) House type (Mid-terrace, End-terrace, Semi-detached, Detached, Bungalow, Flat, Studio, Townhouse, Other (drop down ??" please describe further)) How many reception rooms? How many bedrooms? How many bathrooms? Off-road parking? Garage? Is the property ex-council? Do you own the property? Is the property currently on the market? **If Yes, what is the name of the selling Agent/Website? ****How much is it up for sale for, alternatively, what is a realistic market value of the property? **Does the property have a mortgage? Are there any secondary charges on the property? **In total how much is owing on the property, including any second charges and early repayment penalties? ****How much are your monthly mortgage payments? ****Employment Status? (Employed, self-employed, student, unemployed)**** What is the condition of the property? (new, good, fair, poor) ****Would you like to rent back your home? ****Would you be interested in buying the property back within a pre-arranged time frame, at a pre-arranged price? ****Reason for selling? ****How did you hear about us? ****If we are unable to make an offer can we pass your details to one of our business partners who may have an alternative solution?**