Concrete5 Block to send HTML Form input to CapsuleCRM

We need someone who has experience with developing Packages/Blocks for Concrete5 CMS. ************************************************************************** DO NOT APPLY IF: - You have never developed anything for Concrete5 before. - You can't turn this around in < 2 days - You don't know what CapsuleCRM is ************************************************************************** Overview: -------------- This Block provides a Contact Form that when Submited sends the Person's details to CapsuleCRM. CapsuleCRM will respond with an HTTP 200 response. The Block needs to allow a mix of the following details to be defined during Block creation. When used by a new Contact on page, the Form submission needs to be done via an Ajax call and response and should then hide the input form and display a Success message, or Fail message. If an input is not populated it is not to be included within the Form. There Ajax call needs to display a Timer and have smooth transitions. CSS styling needs to be able to be included as well as what each form element is wrapped in e.g. P or DIV or LI Form input validation should be included as described. HTML Form details: ----------------------- 1) Form Action e.g. URL (required ) 2) HIdden Input FORM_ID (required) 3) Hidden Input COMPLETE_URL 4) Hidden Input REVIEW_ID 5) Hidden Input DEVELOPER 6) Hidden Input SEND 7) Text Input FIRST_NAME (required) 8) Text Input LAST_NAME (required) 9) Text Input PERSON_NAME 10) Text Input ORGANISATION_NAME 11) Text Input TAG (3 of these) 12) Text Input EMAIL (required - check email format) 13) Success message - displayed upon successful response from CapsuleCRM via Ajax call 14) Failure message that includes a link to re-try or clear and start again The Block/Package must be complete and able to be installed on the current stable version of Concrete5.