I need to make some small adjustments to my website. Want Bids in 2 days.

I need to change the input screen of my website where clients can enter information (the quote tab). I have two websites one is [login to view URL] and the other is www.lowcosttruckinsurance.com. I want to change slightly some of the items on the [login to view URL] quote tab and then I want to use the same input quote information screen on my other website www.lowcosttruckinsurance.com. Once the main website is adjusted, then we would need to copy and paste this info to the other website www.lowcosttruckinsurance.com. I also want a person who is on our website to be able to agree to allow us to get their previous accident information by picking a signature of several fonts like on some websites I have seen. We can then use and that signature along with some of the information on the quote transfer to a MS Word document that will be prefilled out where we can send then send that form to several insurance companies. I have attached a sample of the MS form that I am hoping to use where the info will automatically be inputted from the quote page of the website. Lastly I need all the info on the quote from the website to also be sent to me as a comma delimited file or in a excel spreadsheet format so I can use that info to automatically put into my agency management system at our office. As an additional expense I would also like to use an inputted number on the quote sheet to search a website for additional information on that person if that is possible. This would be a separate project, but I want to let the person bidding on the job know that once we work with a person, we will have many items for them to do in addition to this first job of changing the web site quote information.