I need a form to look as close to the attachment as possible. Please use PHP.
1. I need the form information to be submitted to an e-mail address.
2. I need a confirmation e-mail to be sent to the client who submits.
3. I need a message after upload to state either "Your upload was successful, a representative will contact you shortly." or "Your upload was unsuccessful. Please call 281-748-5042 for assistance."