Simple Donation Form - Joomla / Braintree

Here is the following needed for the form. The form should also have a thank you message and details sent via email (provided). Must work with Braintree. Form fields: Enter Amount (Input field) Use of funds: (radial button) Category 1 (radial button) Category 2 (radial button) Category 3 Billing Information First Name* Last Name* Organization Addresss* City* Zip* Country* - dropdown State* Phone* Email* Comment Payment Information Donation Type (radial button) One Time (radial button) Recurring Donation frequency Number occurrences Credit Card Number* Expiration Date* (Month Drop Down, Year Drop Down) Card (CVV) Code* Donate Button