CSS Html Form moving make php Ajax

Hello We already have a form with ajax validations php and everything done, We just need to move this same form, but doing a css new look, and some small validation, to another page: The final form you have to do have to be exactly like this one: [login to view URL] In this image you can see the look we need, and explained the validation needed. We need some expert in css/html/php to do this. We doesnt need a database job or complicated ajaX validations, actually all this is done in the older form. validations are already programmed in the first form. We just need that you move a form from one place to another, and change a little the look. Everything must be working like the first form to finish the job. Thank you