Lead Generator process

I am looking for someone to generate a lead capture process like this one: <[login to view URL]> You will need to have design ability as well, because i do not want to get sued by Approved Index for plagiarism. In all honesty it is so basic in its design, i dont feel it would take much creative skill to improve it. I beleive it is around a 12 part process. we can discuss the exact wording on each page, and my comapny logo/telephone numbers once i have selected a coder. Once the recipient has completed the form, it will need to generate a unique reference number like theirs does, and email the completed form directly to my inbox. Obviously i will need to be sent the unique reference number as well. Maybe it would useful to have it in the actual subject box of the email which is sent to me. That's basically it, very simple for someone that knows what they are doing.