Create pricing database and modify existing html form for website

I am a graphic designer familiar with CSS and HTML- and do not need any visual styling. Currently, customers coming to our site fill in a HTML form which emails details to the appropriate person in our company. We currently have 3 pricing options, regardless of where you live. (see [login to view URL] ) We want to change our pricing structure to be staggered depending on where people live - and we want that to be reflected in our form. Our data is currently stored in a xls spreadsheet, with the following columns: "Suburb" "zone" "monthly price" "bimonthly price" "once off price" and "once off deposit" So a suburb, "Bayswater" might be in "zone 3" which will determine the pricing of our monthly and bimonthly services. Once off services and deposits are the same regardless of zone. The user will select their suburb at the top of the form with a drop-down box, which will populate 3 fields next to it, giving prices for each service (monthly, bimonthly, and once off). The user, with radio buttons, selects a service type. (monthly,bimonthly, green-once off, builders-once off) Once off options also have a "number of items required" field. Additional items have the same deposit per item, but cost less per item. This needs to be taken into account for the final price. Finally, the price is displayed. See attached jpg for a visual, with comments. -------- - Don't worry about styling fields, but they need to be styled with CSS. - Also, I need to be able to update the prices and add suburbs. I can work my way through most file types, it doesn't need to have a cms. Sample of xls file attached (most data is unpopulated). Final version given to successful freelancer.