Modernbill auto sign up form

We need a Modernbill auto sign up form to be setup and configured. The form will allow user to sign up for our various services. We do need the user to authenticate themselves by using their IC# and one other type of ID. You will have to help us customize the sign up form to bear our logo, name and to ensure that the authenticated ID are match against a preconfigured list of users. Need fast turnaround time for this.