Custom "Product" Order Form

Hello everyone, We are currently redesigning the client’s website which they are specialising in sell wholesale of vending machines and products such as toys and candies. They want an online product order form, which is a little beyond our abilities. We are looking for a freelancer to build a custom order form (PHP or equivalent) for us. It is similar to email form. Client want customers to fill out the form - how many quantities what they would want to purchase etc then submit the form. Sale representative will ring customers to verify further such as payment methods and to discuss freight further. It should look similar to this example site - [login to view URL] - Fields: Product Image (Optional), Product name, Code, Price, Qty and Total. - Personal Detail fields are required. - We have more then 50 products so all products will be placed in four sub categories- Gums, Capsule $1, Capsule $2 and Bouncing Balls. - We have too many items so it would be wonderful if you can do jQuery to ensure these categories collapsible to keep order form more tidy. - These product prices have decimals as well. - Auto-sum total is a must. - Product Images would be lovely to add on form but not necessary. - We have SSL certificate already. - Professional look please - Validating email address - Credit Card - that feature is optional for customers to fill it. Client will ring customers to confirm details. - For Freight Cost - information will be posted under the order form. No need to implement code to auto-calculate. We will update the client's website monthly so make sure this order form would be easy for us to understand how to maintain regularly. PLEASE SEE THE MOCKUP ORDER FORM DESIGN which it is attached to this post. Please send us the sample of your works and please do not hesitate to contact us. If you have great alternative solution to this order form, then let us know! We need it ASAP. Many Thanks!