Hello,
I have seen the PDF which you have shared. I think this can be done in .php as well as in .net and depending upon your server, you can pick the hosting. I can do both. As far as I am getting you, you need the page to be translated to HTML format and then provide the form submission.
Do you think the PSD final? Because it looks a little rough, but anyways, if we have to follow it, we can do it.
Looking forward.
Thank You !!