OSC - Simple 1-Page Product Return Form

I need a one page Product Return Form. Before user gets to this page they are prompted to enter the original order number and zip code. That's already in place, using regular POST form. This project does not require user to log into our OSC system. The Request Form page should display of the following, once the Order ID and ZIP Code are validated. The user should be able to correct this information if view/edit indicated: -Customer Details First Name - view only Last Name - view only Company Name - view only Street - view only City - view only State - view only ZIP Code - view only Email - view/edit Telephone Number - view/edit Original Order Date - view only -Product Information Product Number - view only Product Name - view only RMA Product QTY - view/edit RMA Reason - Drop Down Selection ( hardcoded ok) RMA Detail Problem Description - simple entry form. *If there are multiple products, display multiple forms for each of the Product Information. Validation Rules: 1) If Order ID and ZIP do not match, display error message. 2) If original order date is older than 14 days, display error message. 3) RMA Detail Problem Description - is required. Processing the form: 1) When user clicks submit, change the status of the order to "RMA ISSUED" and insert collected data into the ORDER STATUS comments. 2) Send formated email to customer and email destribution ( hardcode ok) Please send in your questions if any.