Build an Online Store

My website is [login to view URL] (in Wordpress) and what I'd like built is the Pricing page. I have attached some-what how I would like this to look/work. Essentially, I would like prospective clients to: 1) Select their zip code, 2) Select their square footage, 3) Select the number of pets in the household and 4) Select the type of clean (Barton Springs, Deep Eddy or Move-out). After this I would like their price range for their initial clean to appear in a box, along with the fixed price for recurring service. (weekly, every 2 weeks and every 4 weeks) On this same page, once they get their estimate, I would like them to input some of their personal information. (the second page of the handwritten attached doc-- I would like to add/remove a few pieces of information here) I would also like clients to be able to enter their cc info, though nothing will be charged through the site. These number will be manually entered into our CRM. I want it to look clean and for any design work I want to work with my designer (she did the design work for the website) for icons, color choices, etc. I have also attached the excel file that we currently use to give quotes. All of this information is a great start, though I'm sure more communication is needed to iron everything out.