Hire a Website Designer

I need a page for my existing web site that can lookup costs, produce a form, capture customer data, send an order via e-mail, and ideally take payment. We have a product for about 100 countries, whose cost varies by year from 1-20. We have a table containing a list of countries and a list of years. For each country-year pair, there is a corresponding price. I need two drop-down boxes on a web page: one for country, one for year. Upon selecting a country-year combination, we need the page to look-up the corresponding cost and displays it. I then need a click to buy button, that captures that country-year-cost trio, then copies it into an order form, where I need to capture the customer's name, address etc., and then send an order to us, i.e. an e-mail to a designated e-mail address. Although we can then handle it manually from there, we'd ideally like to take payment before the order is sent - we have a WorldPay credit card machine, and a PayPal account, so hopefully there is some integration that could be done there - not sure. The country-year-cost data is currently in an access database, or we can provide it as CSV or excel data. The data will need to be updated periodically (every 3 months). If necessary, we can set-up a sub-domain on our web site, which points to the custom page(s), if integration into our existing WebPlus X8 web site is not possible.