Online Application Needed for a Website

Hello, I have a car dealership website in WordPress. I'm currently in the process of getting an SSL certificate for that page, so that clients can securely submit a credit app directly to me. The site itself is in WordPress, but I would like the application page to be done in either HTML or PHP, not inside the WordPress platform. I need to hire a designer or programmer to create the credit application for me. I have the form already done using Contact Form 7, but its extremely limiting as far as options and dropdowns and features, that's why I don't want it done in WordPress. I would like the application page to be done in either HTML or PHP. It'll be on a SSL SECURE page, however, so whatever works best. I can provide you the link to the form I created, which you can basically just copy, and add the addtional requirements which I will also send you. Again, its for ONE PAGE, WITH ONE FORM. NOT AN ENTIRE WEBSITE. Please bid competitively. I don't want to spend more than $50 for this. Also, I will have a local programmer review the code and make sure it has no malicious code or bugs. IF ANY MALICIOUS CODE OR BUGS ARE FOUND, I WILL NOT PAY, AND WILL REPORT YOU. Its a simple job, but please be professional and have prior experience with web forms. Thank you.