Only respond if you can complete the entire project.
This is a one page website featuring a short mortgage application for people apply for loans online.
example of data entry fields can be seen on this website:
[url removed, login to view];rfqType=35&cmd=submit&stage=0&page=0&reallySubmit=1&state=Select+One&trackingCode=&search=b_6monthlows&tm=y
(sorry about the long address)
Also I need a secure online database to manage and count the "leads" submited through the webpage. the description of the functionality needed for the database can be view in the powerpoint file attached.