Greeting,
Do you have any reference website, any document prepared? What color combination you prefer? Lets discuss your requirements according to that we will proceed. I am sure 100% i will make a page and you can collect user information easily .
Your page will be responsive for all latest browsers and device size. I have great command custom coding with Php, html5/css3, bootstrap, ajax, jquery, json,
ajax etc.
My Aim is to provide 100% Client satisfaction on project delivery.
Do you have any query? I am available to discuss right now.
Thanks and Regards
Sam