single item e-commerce page

Need a credit card collection page. Needs to collect name, address, billing info, card numbers, exp. date, cvs number, item description, and amount total. ******* New updated info ****** Many of the bidders are making this a much bigger project then it needs to be. I do **NOT** require a shopping cart, tax calulations, shipping calulations, catalog of products, inventory controlls, or even pictures. Link Point is my merchant account company. Currently my customers have to call me on the phone and I manual process the order. I only use this system a couple four or five times a week, so it's not high volume automation I'm worried about. This page is for my non-paypal buyers who want to use credit cards. I want to skip the phone calls and allow orders 24/7 without a phone call. I don't have a Secure Server, so I will use email. This is a single page checkout form. My customer enter their address and card number, a brief typed description of the item, and a note and a tip amount and hit submit. Validation question to see if my entire description was read, what is your favorite color. Bidders that don't answer this question in their offer message will not be accepted, back to the project...the email needs to be sent to me safetly some how. Once I get the email from a customer I will manually enter the info into my POS (point of sale) system I have with <[login to view URL]> **_Important details as well _**My email address needs to be safe from spiders and spam. My customer info that is sent to me needs to safe (encoded?) If this can't be done with regular email, please suggest something. ## Deliverables Rent A Coder requirements notice: As originally posted, this bid request does not have complete details. Should a dispute arise and this project go into arbitration "as is", the contract's vagueness might cause it to be interpreted against you, even though you were acting in good-faith. So for your protection, if you are interested in this project, please work-out and document the requirements onsite. 1) Complete and fully-functional working program(s) in executable form as well as complete source code of all work done. 2) Deliverables must be in ready-to-run condition, as follows (depending on the nature of the deliverables): a) For web sites or other server-side deliverables intended to only ever exist in one place in the Buyer's environment--Deliverables must be installed by the Seller in ready-to-run condition in the Buyer's environment. b) For all others including desktop software or software the buyer intends to distribute: A software installation package that will install the software in ready-to-run condition on the platform(s) specified in this bid request. 3) All deliverables will be considered "work made for hire" under U.S. Copyright law. Buyer will receive exclusive and complete copyrights to all work purchased. (No GPL, GNU, 3rd party components, etc. unless all copyright ramifications are explained AND AGREED TO by the buyer on the site per the coder's Seller Legal Agreement). ## Platform I don't know what goes here. Needs to work with internet explorer and either my email program or link point.