Online Reservation Form

I need a taxi reservation form. I previously used freelancer to have the previous form built ([login to view URL]), but the form is low quality and sometimes gives error messages. I would like: 1. receive a file with all code contained that I can simply add into the content of every page of my website. 2. make sure that this form uses VERY simple to read captcha-the current from has LOTs of spam that comes in. 3. It needs to be an intelligent form: Date Selector, Time Selector, Email Address Verifier, etc. 4. Needs to be a top notch form that I can later add fields to if necessary and the form should still work. I need it done ASAP.