Build Custom Interactive Page for Existing site

I need to Develop an Interactive Custom Page for my site. Summary. I'm creating a Martini Contest for a bar and I want to build a page that will allow the user to interactively build their own Martini. The user will be able to choose from a list of Liquors (Vodkas, Gins,) and Flavors/Ingredients. The UI should have an Empty Martini Glass that is filled with the ingredient that the user picks. Each Ingredient Picked will appear above the Martini Glass Showing the Content of the Drink which the user will be able to Name Example: Name "Dave's Martini" Ingredients "Grey Goose Vodka" "Olive Juice" "Lemon Twist Flavoring" (Interactive Martini Glass) I will be using this as a way to capture emails. I'll need to develop a Pop Up that comes when the 3rd or 4th Ingredient is chosen that says "This Looks Like a Great Martini! Enter Your Email Address to Submit this to our Martini Contest" As soon as they submit they're email address they can continue building the Martini. A database will need to be made to store email addresses given. I would like to have a Mock Up of this included into the Price, and Delivered After the First Milestone Payment. Here is Our site for Reference [login to view URL]