Email Form and Website Cleanup

I have an email form on my website [login to view URL] that I need some additional work performed on. I need to add a drop down menu for "Choose Your Locator" then all the locator names will be within the drop down. This needs to be a mandatory field. Once a visitor selects their agent, the email of that agent is populated on the back end and lets that form know to what address the information should be sent to after selecting all the information they would like, and pressing Submit. I as well need the Comment Section to work. Right now, if you write in the Comment Section, it does not come across on the email. If you have any ideas on how to clean up my website and just making it a little more pleasing to the eye, that would be great too. Please give me a price quote for the Email Form, and another quote for the Clean Up.