Build a similar type form - R&D

We want a different way of doing forms - Coder will combine this page example [login to view URL] with the test data [login to view URL] to generate a simple price calculation in an html5 page. The task is to combine the two styles and calculations to create our new form. The final html5 page will be mobile friendly with questions and proper calculations must use font awesome icons (svg) instead of dropdowns. We like this style/format [login to view URL] BUDGET $157 Max Timeline to complete - deadline 4/days Max ** Auto responses will be deleted automatically - Use the word "Lobster" when you bid. Will want to ask for the user's name, e-mail, and phone like the example [login to view URL] (information demo) right side. We have a total of 11 maximum questions. A few similar questions as seen on: [login to view URL] ** Will provide the remaining questions to the coder qualified. See example. EXAMPLE QUESTIONS: Hey stranger, we are dying to get to know you better! 1. What is your name _____ 2. Hello ____ What can we help you with? Select all that apply: 1. Option one 2. Two 3. Three 4. Four html5, jquery, css3, mobile friendly a must.