This project would be a template that I can later modify some fields for the end user to see as my business needs change.
I want to place it on my wordpress site to allow a consumer to fill out fields, hit a submit button and they would be delivered a personal email letting them know they completed it.
Form needs to be easy to navigate with some drop downs, etc.
The form would be delivered to me in a easy to read and modifiable format (preferably Word)
I attached an internal form as an example of the basic fields that I would want on the web form.