155599 Order form for resell servers

I need a cutomized order form for reseller servers online like this: [login to view URL] as u can see the order form have different option, this based server options can be enabled or disabled from admin panel. When the customer choosed the server configuration must add all the information (look the Final Step) and will decide if pay with Paypal or money transfer. The order sent from the customer will be stored in the database and me and the customer must receive the order mail notification. Thanks