asp dynamic web form html java php NOW

I need somebody NOW to help me with a form as follows: The form must contain two <option> fields. Depending on their selection a special text has to be printed and the purchase price. There must be the option to add / remove products (can be done with javascript). Below this fields I need a calculation of the total price depending on how many products are purchased AND depending on the total value a delivery fee must be added or not if total value is above a certain price. In addition customer must enter their details (name, email, address ...) For an example please see here: [login to view URL] (just the design could be better). Must be done RIGHT NOW, budget max. $30