Need Order Forms for Order Site

I am getting ready to start a web hosting business, and require a simple, but information intense order form which will collect the customers information securely, as well as collect the customers Credit Card Information and store it where it can be viewed for manual processing, or can be charged to the credit card right away, with the help of the gateway processing code from our Merchant Services company. As well, the script would have to be automated in regards to successful orders, it would have to send out an automated email to customers. ## Deliverables 1) Complete and fully-functional working scripts(s) in executable form as well as complete source code of all work done. 2) Installation package that will install the software (in ready-to-run condition) on the platform(s) specified in this bid request. 3) Complete ownership and distribution copyrights to all work purchased. 4) Script must be able to be easily moved from server to server without breaking ## Platform Windows 2000 Server, It can be done in PHP, CGI, ASP, ASP.NET I dont care as long as it is professional and as long as it works.