Miracles group - Email customer request form page

I need a new page called "Manual Quote Request Form" With a link called "Manual Quote Request Form" at the bottom of the contact us links in footer. On the page to say: Header: Manual Quote Request Form Fill in all the information fields below to request a manual quote. Please note, if your items are under the $300 minimum, we will round it up to the minimum. If your event is outside Canberra / Queanbeyan metro we cannot provide a quote. All conditions must be read here: [login to view URL] before requesting a quote. If your order does not meet the conditions, we will not send you a quote. Please note, you can also receive an instant quote by registering (at the top right of this page) then send through an order. Your order remains a quote until we receive a downpayment. Field 1) <first name> <last name> <company name> Field 2) <email address> Field 3) <mobile phone number> <alternate phone number> (these can't be the same) Field 4) <delivery address> <suburb> <postcode> Field 5) <drivers licence number> <drivers licence state> Field 6) <delivery date> <morning or afternoon delivery?> <pickup date> Field 7) <purchase order number> Field 8) <equipment required and quantity> (large size field) Field 9) <Would you like McHugh Hire to clean the equipment after use or clean it yourself?> Button at bottom <Submit Quote Request> Miracles instruction: All fields are required except for the <purchase order number> field When submitted, it needs to be sent to our bookings@mchu..... address and the customer's email address. The customer will be directed to a page that says "Thank you, your manual quote request has been submitted!" The email should say: Thanks for your manual quote request, we will send you a quote shortly! All fields information to also be on the email.